Cancer treatment with epothilones

ABSTRACT

The invention relates to the treatment of a proliferative disease, especially according to certain treatment regimens, with an epothilone, especially with epothilone A and more preferably epothilone B; as well as to the treatment of certain cancers with such an epothilone.

SUMMARY OF THE INVENTION

The invention relates to the treatment of a proliferative disease,especially according to certain treatment regimens using an epothilone,especially epothilone B; preferably of a gastrointestinal tumor, morepreferably (1) a tumor of the colon and/or the rectum (colorectaltumor), especially if it is refractory to a (meaning at least one)representative of the taxane class of anti-cancer agents, in particularTAXOL® (paclitaxel in formulated form for clinical use), and/or at leastone standard treatment with an other chemotherapeutic, especially5-fluorouracil; (2) a tumor of the genitourinary tract, more preferablya tumor of the prostate, including primary and-metastatic tumors,especially if refractory to hormone treatment (“hormone refractoryprostate cancer”) and/or treatment with other standardchemotherapeutics; (3) an epidermoid tumor, more preferably anepidermoid head and neck tumor, most preferably a mouth tumor; (4) alung tumor, more preferably a non-small cell lung tumor, especially anyof these tumors that is refractory to treatment with one or more otherchemotherapeutics (especially due to multidrug resistance), especiallyto-treatment with a member of the taxane class of anti-cancer agents, inparticular TAXOL®; or (5) a breast tumor, more preferably one that ismultidrug resistant, especially refractory to treatment with a member ofthe taxane class of anti-cancer agents, in particular TAXOL®; relatingespecially also to the treatment of a multidrug resistant lung tumor(preferably a non-small cell lung tumor), a multidrug resistant breasttumor, or a multidrug resistant epidermoid tumor, or in a broader senseof the invention to a treatment schedule for the treatment of anaforementioned or (in a broader sense of the invention) any other tumor,especially if it is refractory to one or more chemotherapeutics,especially multidrug resistant and/or TAXOL® refractory), such as amelanoma, ovarian cancer, pancreas cancer, neuroblastoma, head and neckcancer or bladder cancer, or in a broader sense renal, brain or gastriccancer; by administration of an epothilone as a cytotoxic agent,especially epothilone B; the term “treatment” also encompassing (i) amethod of treatment for (=for treating of) said disease comprisingadministration of said cytotoxic agent (preferably an epothilone,especially epothilone B, in each case preferably together with apharmaceutically acceptable carrier) to a warm-blooded animal,especially if in need of such treatment, in a therapeutically effectiveamount, in at least one treatment; (ii) the use of said cytotoxic agent,for the treatment of a proliferative disease; (iii) the use of saidcytotoxic agent for the manufacture of a pharmaceutical preparation forthe treatment of said proliferative disease (comprising admixing saidcytotoxic agent with a pharmaceutically acceptable carrier); (iv) apharmaceutical preparation comprising a dose of said cytotoxic agentthat is appropriate for the treatment of said proliferative disease. Theinvention is, in a preferred embodiment, directed to the treatment ofpatients or patient groups where other treatments, especially standardtreatment with an other chemotherapeutic, especially 5-fluorouracil; ortherapy with members of the taxane class of anti-cancer agents, such asTAXOL®, have failed.

BACKGROUND OF THE INVENTION

Cancer still represents a major unmet medical need. Initial treatment ofthe disease is often surgery, radiation treatment or the combination,but recurrent (metastatic) disease is common. Chemotherapeutictreatments for most cancers are generally not curative, but only delaydisease progression. Commonly, tumors and their metastases becomerefractory to chemotherapy, in an event known as development ofmultidrug resistance. In many cases, tumors are inherently resistant tosome classes of chemotherapeutic agents [see DeVita V. T., Principles ofCancer Management: Chemotherapy. In: Cancer. Principles and Practice ofOncology. DeVita V. T. et al (eds.), 5th edition, Lippincott-Raven,Philadelphia, New York (1977), pp. 333-347; or Cleton, F. J.,Chemotherapy: general aspects. In: Oxford Textbook of Oncology; Peckham,M., et al, Oxford University Press, Oxford, New York, Tokyo (1995), Vol.1, pp. 445-453]. This is, for example, the case for lung tumors,especially non-small cell lung carcinoma, or also for epidermoid tumors,like epidermoid head and neck, especially mouth, tumors, or also forbreast tumors. Other mechanisms why tumors are not treatable (arerefractory to treatment) can be, for example, the presence of tubulinmutations or glutathione mediated mechanisms.

Intestinal, especially colorectal, cancer defines a special case of theunmet medical needs in cancer treatment. Initial treatment of thedisease is often surgery, radiation treatment or the combination, butrecurrent (metastatic) disease is common. First-line chemotherapeutictreatments for recurrent colorectal cancer include 5-fluorouracil. Butthis treatment provides at best delay of disease progression as thetumors usually become refractory to treatment. Chemotherapy of thisrefractory stage of disease involves other classical cytotoxic agents,but are all considered inadequate [see Cohen et al., Cancer of thecolon. In: Cancer. Principles and Practice of Oncology; DeVita et al.(eds.), 5th edition, Lippincott Raven. Philadelphia, New York 1997, pp.1144-1197; or Rowinsky, Ann. Rev. Med. 48, 353-74 (1997)]. Also forcancer of the genitourinary tract, especially prostate cancer, a furtherunmet medical need, initial treatment is as mentioned above forcolorectal cancer, showing similar problems. First-line chemotherapeutictreatment for recurrent prostate cancer includes anti-androgens, and therecurrence is frequently androgen-dependent. But this treatment providesonly delay of disease progression as the tumors almost always becomerefractory to anti-androgens within 6 months to 2 years(hormone-refractory prostate tumors). Chemotherapy of this anti-androgenrefractory stage of diseases involves mitoxantrone or other classicalanticancer cytotoxic agents, but all are considered as inadequate [seeOesterling et al., Cancer of the prostate. In: Cancer. Principles andPractice of Oncology. DeVita, V. T., et al. (eds.), 5th edition,Lippincott-Raven, Philadelphia, New York 1997, pp 1322-86; Sternberg,Cancers of the genitourinary tract. In: Cavalli et al. (eds.), Textbookof Medical Oncology; or Roth, B. J., Semin. Oncol. 23(6 Suppl. 14),49-55 (1996)].

Among cytotoxic agents for the treatment of tumors, TAXOL® (paclitaxel),a microtubule stabilizing agent, has become a very important compoundwith a remarkable economic success [see Rowinsky E. K., The developmentand clinical utility of the taxane class of antimicrotubule chemotherapyagents; Ann. Rev. Med. 48, 353-374 (1997)].

However, TAXOL® has a number of disadvantages. Especially its extremelylow solubility in water represents a severe problem. It has becomenecessary to administer TAXOL® in a formulation with Cremophor EL®(polyoxyethylated castor oil; BASF, Ludwigshafen, Germany) which hassevere side effects, causing inter alia allergic reactions that in onecase even were reported to have led to the death of a patient. Moreseverely, certain tumor types are known to be refractory to treatmentwith TAXOL® even when the drug is administered as front-line therapy, orthe tumors develop resistance to TAXOL® after multiple cycles ofexposure.

Although the taxane class of antimicrotubule anti-cancer agents has beenhailed as the “perhaps most important addition to the chemotherapeuticarmamentarium against cancer over the past several decades” [seeRowinsky E. K., Ann. Rev. Med. 48, 353-374 (1997)] and despite thecommercial success of TAXOL®, there remain limitations to TAXOL®'sefficacy. TAXOL® treatment is associated with a number of significantside effects and some major classes of solid tumors, namely colon andprostate, are poorly responsive to this compound (see Rowinsky E. K.,loc. cit.). Specifically, as a single agent, TAXOL® has been consideredto be poorly active clinically in colorectal, renal, prostatic,pancreatic, gastric and brain cancers [see Rowinsky E. K., loc. cit.;Bitton, R. J., et al., Drug Saf. 12, 196-208 (1995); or Arbuck, S. G.,et al., J. Natl. Cancer Inst. Monogr. 15, 11-24 (1993)]. For example,the effectiveness of TAXOL® can be severely limited by acquired drugresistance mechanisms occurring via various mechanisms, such asoverexpression of phosphoglycoproteins that function as drug effluxpumps.

Therefore, there exists an urgent need to find compounds and appropriatedosing regimens with these compounds expand the armamentarium of cancertreatment, especially in the majority of cases where treatment withtaxanes and other anticancer compounds is not associated with long termsurvival.

The epothilones, especially epothilones A and B, represent a new classof microtubule stabilizing cytotoxic agents (see Gerth, K. et al., J.Antibiot. 49, 560-3 (1996); or Hoefle et al., DE 41 38 042), e.g. withthe formulae:

wherein R is hydrogen (epothilone A) or methyl (epothilone B).

These compounds have the following advantages:

(i) they show better water solubility than TAXOL® and are thus moreappropriate for formulation; and

(ii) they have, in cell culture experiments, been reported to be activealso against the proliferation of cells that, due to the activity of theP-glycoprotein efflux pump which renders them multidrug resistant, showresistance to treatment with other chemotherapeutics e.g. TAXOL® [seeBollag, D. M., et al., “Epothilones, a new class ofmicrotubule-stabilizing agents with a Taxol-like mechanism of action”,Cancer Research 55, 2325-33 (1995); and Bollag D. M., Exp. Opin. Invest.Drugs 6, 867-73 (1997)]; and

(iii) despite apparently sharing the same, or a sterically proximalbinding site on the microtubule, the epothilones have been shown to beactive against a TAXOL®-resistant ovarian carcinoma cell line with analtered β-tubulin [see Kowalski, R. J., et al., J. Biol. Chem. 272(4),2534-2541 (1997)].

On the other hand, they are highly toxic and therefore their usefulnessin the treatment of cancer in vivo was considered practically impossible[see, for example, PNAS 95, 9642-7 (1998)]. Therefore, the presentinvention shows in an unexpected way that indeed dosage regimens may befound that allow, on the one hand, to treat tumors with epothilones,especially epothilone B; and on the other hand allow for the treatmentof certain patient groups that are unresponsive to other kinds oftreatment, be it by multi-drug resistance, as with taxane, e.g. TAXOL®,refractoriness due to multidrug resistance, and/or any other mechanism.

The present invention has the goal to present for the first time in vivoregimens for a useful treatment with epothilones, preferably epbthiloneA or especially epothilone B, that allow for the treatment of a tumordisease, e.g. a melanoma, ovarian cancer, pancreas cancer,neuroblastoma, head and neck cancer, bladder cancer, renal, brain,gastric or preferably a colorectal, prostate, breast, lung (especiallynon-small cell lung) or epidermoid, e.g. epidermoid head and neck,especially mouth, cancer.

While the general treatment schedule allows for the treatment of varioustumor types already in front-line treatment, the invention preferablyrelates to the treatment of tumors that can be expected or have shown tobe refractory to treatment with other chemotherapeutics, e.g. standardtreatment with one or more other chemotherapeutics, especially with5-fluorouracil and/or taxane, e.g. TAXOL® treatment.

Surprisingly, it has now been found that even the proliferation of tumorcells and tumors that are refractory to standard treatment with otherchemotherapeutics, e.g. 5-fluorouracil; and/or to treatment with amember of the taxane class of compounds, most especially TAXOL®,especially of a colorectal tumor, especially one that is also refractoryto standard treatment, e.g. with 5-fluorouracil; or of a lung tumor,especially a non-small cell lung cancer; an epidermoid, more preferablyepidermoid head and neck, such as mouth, tumor; or a breast tumor;and/or metastasis thereof can be diminished or stopped and that evenregression or tumor disappearance is possible.

DETAILED DESCRIPTION OF THE PREFERRED ASPECTS OF THE INVENTION

The present invention deals preferably with the following subject matteras part of the invention:

Whenever within this whole specification “treatment of a proliferativedisease” or of a tumor, cancer or the like is mentioned, there is meant

a) a method of treatment (=for treating) of a proliferative disease,said method comprising the step of administering (for at least onetreatment) an epothilone, especially epothilone A and/or B, especiallyB, (preferably in a pharmaceutically acceptable carrier material) to awarm-blooded animal, especially a human, in need of such treatment, in adose that allows for the treatment of said disease (=a therapeuticallyeffective amount), preferably in a dose (amount) as specified to bepreferred hereinabove and hereinbelow;

b) the use of an epothilone, preferably epothilone A and/or B,especially epothilone B, for the treatment of a proliferative disease;or an epothilone, especially epothilone B, for use in said treatment(especially in a human);

c) the use of an epothilone, especially epothilone A and/or B,especially epothilone B, for the manufacture of a pharmaceuticalpreparation for the treatment of a proliferative disease; and/or

d) a pharmaceutical preparation comprising a dose of an epothilone,especially epothilone A and/or B, most especially epothilone B, that isappropriate for the treatment of a proliferative disease; or anycombination of a), b), c) and d), in accordance with the subject matterallowable for patenting in a country where this application is filed;

e) a method of using an epothilone for the manufacture of apharmaceutical preparation for the treatment of a proliferative disease,comprising admixing said epothilone with a pharmaceutically acceptablecarrier. In cases where a tumor disease or a specific tumor (e.g. colontumor, colon carcinoma or colon cancer; or prostate tumor, prostatecarcinoma or prostate cancer) are mentioned instead of “proliferativedisease”, categories a) to e) are also encompassed, meaning that therespective tumor disease can be filled in under a) to e) above insteadof “proliferative disease”, in accordance with the patentable subjectmatter.

In a first aspect, the present invention relates to the treatment of aproliferative disease that is refractory to treatment with one or moreother chemotherapeutics, where an epothilone, especially epothilone Aand/or B, especially epothilone B, is administered to a warm-bloodedanimal, especially a human, preferably a human in need of suchtreatment, especially in a therapeutically effective amount.

In a second aspect, the present invention relates to an in vivo regimenfor the treatment of a proliferative disease, especially a cancer thatis refractory to treatment with one or more other chemotherapeutics,especially of the taxane class, like TAXOL®, and/or 5-fluorouracil,where an epothilone, especially epothilone A and/or B, especiallyepothilone B, is administered in a dose that is between about 1 andabout 100%, preferably between about 25 and 100%, of the (singleadministration) maximal tolerated dose (MTD) to a warm-blooded animal,especially a human; and one or more (preferably two to seven) furtherdoses preferably each within the dose range mentioned just above areadministered in one or preferably more than one further treatmentcycle(s), especially with an interval between the treatment cycles ofone week or more than one week after the preceding treatment, morepreferably after about one to about 6 weeks, most preferably about oneto about three weeks after the preceding treatment, respectively.Generally, this treatment regimen where a high dose is administered intwo or more treatment cycles with periods of time between one to six,preferably one to three weeks of time between administrations ispreferred over more frequent treatments with lower doses, especially asit should reduce the frequency and duration of hospitalization and as itshows superior antitumor effects and less toxicity than more frequenttreatments and more antitumor efficacy than less frequent treatment.

Preferably, for epothilone B the dose in humans to be used is calculatedaccording to the formula (I)single dose (mg/m²)=(0.1 to y)×N   (I)where N (a whole (like 1, 2 or 3) or fractional number (like 1.5 or 2.3)wherever mentioned hereinbefore and hereinafter)) is the number of weeksbetween treatments (preferably a number in the range of about 1 to about6 (corresponding to an interval of about 1 to about 6 weeks), especiallyabout 1 to about 3 (corresponding to a preferred interval of about 1 toabout 3 weeks) and y is 6 or preferably 5, more preferably 4.

More preferably, the treatment dose is calculated according to theformula IIsingle dose (mg/m²)=(0.1 to 2.5)×N;   (II);even more preferably according to the formula III,single dose (mg/m²)=(0.1 to 1.7)×N;   (III);or most preferably according to the formula IVsingle dose (mg/m²)=(0.1 to 1)×N   (IV)where, in each of formulae II to IV, N has the meaning given underformula I. For the dosages calculated according to any of the formulae Ito IV, the following proviso must be met: The dose, even if calculatedhigher, shall not exceed about 18 mg/m² for a single administration.

Preferably, for weekly treatment the dose is between about 0.1 and about6, preferably about 0.1 and about 5 mg/m², more preferably about 0.1 andabout 3 mg/m², even more preferably 0.1 and 1.7 mg/m², most preferablyabout 0.3 and about 1 mg/m²; for three-weekly treatment (treatment everythree weeks or every third week) the dose is between about 0.3 and about18 mg/m², preferably about 0.3 and about 15 mg/m², more preferably about0.3 and about 12 mg/M², even more preferably about 0.3 and about 7.5mg/m², still more preferably about 0.3 and about 5 mg/m², mostpreferably about 1.0 and about 3.0 mg/m². This dose is preferablyadministered to the human by intravenous (i.v.) administration during 2to 180 min, preferably 2 to 120 min, more preferably during about 5 toabout 30 min, most preferably during about 10 to about 30 min, e.g.during about 30 min.

Preferably, especially in the case of weekly treatment, rest periods ofmore than one week, more preferably of two to ten weeks, more preferablythree to six weeks after the preceding treatment may be necessary afterfor example 3, 4, 6, 8, or more treatment cycles, depending on patientcondition, to allow for sufficient recovery from the precedingtreatment.

In a third aspect of the invention, the present invention relates to anin vivo regimen for the treatment of a proliferative disease, especiallyone that is refractory to the treatment with one or more otherchemotherapeutics, where an epothilone, preferably epothilone A and/orB, especially epothilone B, is administered weekly to a warm-bloodedanimal, especially a human, in a dose that is below 80%, more preferablybelow 50% of the maximal tolerable dose (MTD).

In a fourth aspect, the invention relates to the in vivo treatment of aproliferative disease that is refractory to the treatment with one ormore other chemotherapeutics, especially 5-fluorouracil or a microtubulestabilizing agent of the taxane class, especially TAXOL®, for example amultidrug resistant tumor, where an epothilone, especially epothilone B,is administered to a warm-blooded animal, especially a human.

In a fifth aspect, the invention relates to the in vivo treatment of aproliferative disease, especially one that is refractory to thetreatment with one or more other chemotherapeutics, by combinedadministration (a) of an epothilone, preferably epothilone A and/orepothilone B, especially epothilone B, in combination with (b) anotherantitumor chemotherapeutic, preferably the combined treatment beingtimed so that component (a) and (by are administered to a warm-bloodedanimal, especially a human (especially in need of such treatment), incombination in a quantity which is jointly therapeutically effectiveagainst a proliferative disease that preferably can be treated byadministration of an epothilone, more preferably epothilone A and/orepothilone B, especially epothilone B; said administration preferablytaking place to a human that suffers from a tumor that is refractory toother chemotherapeutic treatment, e.g. treatment especially with5-fluorouracil or especially with a member of the taxane class ofanti-cancer agents, like TAXOL®.

In this regard, the invention also relates to a combination preparationcomprising components (a) and (b) as defined in the last paragraph.

The invention also relates to a product which comprises component (a)and component (b) as defined in the second paragraph above, in thepresence or absence of one or more pharmaceutically acceptable carriermaterials, as a combination preparation for simultaneous orchronologically staggered administration to a warm-blooded animal,especially a human, within a period of time which is small enough forthe active compounds both of component (a) and of component (b) tomutually enhance antiproliferative activity especially againstproliferating cells) in said warm-blooded animal, for treating aproliferative disease.

The general terms used hereinbefore and hereinafter preferably have thefollowing meanings, if not defined otherwise:

A proliferative disease is mainly a tumor disease (or cancer) (and/orany metastases), wherever the tumor or the metastasis are located), moreespecially a tumor selected from the group comprising breast cancer,genitourinary cancer, lung cancer, gastrointestinal cancer, epidermoidcancer, melanoma, ovarian cancer, pancreas cancer, neuroblastoma, headand neck cancer (this term, wherever it is used, meaning a head and/orneck cancer, meaning that not only a cancer of head and neck, but alsoof head or neck is envisaged) or bladder cancer, or in a broader senserenal, brain or gastric cancer; more preferably (i) a tumor selectedfrom a breast tumor; an epidermoid tumor, especially and epidermoid headand neck, preferably mouth, tumor; and a lung tumor, especially anon-small cell lung tumor; or from a gastrointestinal tumor, especiallya colorectal tumor; and a genitourinary tumor, especially a prostatetumor (especially a hormone-refractory prostate tumor); or (ii) (morepreferably) a proliferative disease that is refractory to the treatmentwith other chemotherapeutics, therapeutics, especially a correspondingtumor (and/or any metastasis), more especially a tumor selected from thegroup comprising tumors that are refractory to a standard treatment with(an)other chemotherapeutic(s), especially with 5-fluorouracil and/or(preferably) a microtubule stabilizing agent of the taxane class, mostespecially TAXOL®, still more preferably a tumor selected fromgastrointestinal, e.g. colorectal (especially refractory to standard,e.g. 5-fluorouracil, and/or TAXOL® treatment); and genitourinary, e.g.prostatic tumors (and/or a metastasis thereof, especially a metastasisthereof); most preferably a gastrointestinal tumor, especially acolorectal cancer; or (iii) a tumor that is refractory to treatment withother chemotherapeutics due to multidrug resistance, especiallyrefractory to a member of the taxane class of microtubule stabilizingagents, preferably TAXOL®, most especially a multidrug, especiallyTAXOL®, resistant lung tumor (especially a non-small cell lung tumor), amultidrug resistant breast tumor, or a multidrug resistant epidermoid,preferably epidermoid head and neck, most preferably mouth, tumor.

In a broader sense of the invention, a proliferative disease mayfurthermore be selected from hyperproliferative conditions such ashyperplasias, fibrosis (especially pulmonary, but also other types offibrosis, such as renal fibrosis), angiogenesis, psoriasis,atherosclerosis and smooth muscle proliferation in the blood vessels,such as stenosis or restenosis following angioplasty.

Where hereinbefore and subsequently a tumor, a tumor disease, acarcinoma or a cancer are mentioned, also metastasis in the originalorgan or tissue and/or in any other location are implied alternativelyor in addition, whatever the location of the tumor and/or metastasis is.

The word “refractory” means that the respective proliferative disease(especially a tumor and/or any metastasis thereof), upon treatment witha (meaning at least one) chemotherapeutic other than an epothilone,shows no or only weak antiproliferative response (no or only weakinhibition of tumor growth) after the treatment with such an agent, thatis, a tumor that cannot be treated at all or only with unsatisfyingresults with other (preferably standard) chemotherapeutics (preferablyas defined above, especially 5-fluorouracil (especially in the case ofcolorectal, like colon, cancer), antiandrogens or preferablymitoxantrone (especially in the case of prostate cancer), orantiestrogens, like letrozole (especially in the case of breast cancer);or especially a member of the taxane class of chemotherapeutics, e.g.TAXOTERE® or TAXOL®, in a warm-blooded animal, especially a human; forexample the tumor growth is not stopped, only retarded slightly or noregression is found. The present invention, where treatment ofrefractory tumors and the like is mentioned, is to be understood toencompass not only (a) tumor(s) where one or more chemotherapeutics havealready failed during treatment of a patient, but also (a) tumor(s) thatcan be shown to be refractory by other means, e.g. biopsy and culture inthe presence of chemotherapeutics. Where a term like “refractory againstTAXOL®” is used hereinbefore and hereinafter, this term, in addition tothe finished product, is also intended to mean paclitaxel, the activesubstance of TAXOL® “Refractory to hormone treatment” or “hormonerefractory”, in the case of a tumor of the genitourinary tract,especially a prostate tumor, means refractory to treatment with anantiandrogen.

TAXOL® preferably stands for the finished product that comprisespaclitaxel, but, in a broader sense, is also meant to encompasspaclitaxel itself of any other paclitaxel formulation with one or morecarrier material(s).

Preferably, the term refractory means that with standard dose areduction of tumor growth by less than 50% (that is a T/C % value ofequal to or more than 50%) is obtained when compared with a controlwithout chemotherapeutic, e.g. by in vivo or in vitro measurements.

Multidrug resistant tumor disease is one where resistance to one or morechemotherapeutics, including those of the taxane class, especiallyTAXOL®, or the anthracycline class, especially ADRIAMYCIN®, is found.The basis for this resistance is the export via an energy (especiallyATP)-dependent pump located on the surface of cells of the respectivetumor, especially of the P-glycoprotein family, especiallyP-glycoprotein (P-gp) itself. In the present invention, alternatively orin addition other mechanisms may cause a tumor to be refractory totreatment with chemotherapeutics other than an epothilone. For example,alterations in the drug target (especially microtubules in the presentcase), changes in the intracellular metabolism that may inactivate thecompound, or changes in the physiology of the cell that would facilitateby-passing or overriding of the mechanism of drug action may lead tosuch resistance.

By the term “other chemotherapeutic” or “standard chemotherapeutic”,there is meant especially any chemotherapeutic other than an epothilone;preferably one as defined in the introduction, especially 5-fluorouracil(especially in the case of colorectal, like colon, cancer), ananti-androgen or mitoxantrone (especially in the case of prostatecancer), or an antiestrogen, like letrozole (especially in the case ofbreast cancer); especially, the term refers to 5-fluorouracil or (morepreferably) to members of the taxane class of microtubule stabilizingagents, such as preferably Taxotere® or more preferably TAXOL®.“Standard treatment with other chemotherapeutics”, “otherchemotherapeutic treatment” or “standard chemotherapy” is referring totreatment with at least one such “other” or “standard therapeutic”.

By the term epothilone, any epothilone or epothilone derivative ismeant. Preferably, the term “epothilone” means epothilone A, epothiloneB, any epothilone derivative disclosed in WO 98/25929 (which isincorporated by reference), or any mixture thereof; more preferably, itmeans epothilone A and/or epothilone B, and most preferably it relatesto epothilone B.

The administration in all cases mentioned above and below may take placeorally but, in view of better and better defined bioavailability, morepreferably is made parenterally, especially intravenously, e.g. byinfusion or injection. Where subsequently “infusion” is used, this meanspreferably intravenous infusion, which is the most preferred mode ofadministration.

Subsequently, the data for adults are the basis for illustration.However, it goes without saying that the present invention also relatesto the treatment of proliferative diseases in pediatrics. The doses mustthen be corrected in accordance with standard methods and the age,condition and other characteristics of the patient.

The Maximal Tolerated Dose (MTD) is determined according to standardprocedures; preferably, in warm-blooded animals the MTD in case of oralor intravenous administration is determined as the Dose of a singleadministration where no death occurs and a loss of body weight of lessthan 40, preferably less than 25, percent (%) is found in the treatedwarm-blooded animal individual (this term here mainly referring to ananimal; for humans see below).

The MTD may vary depending on the population of the patients which maybe defined by tumor type, age range, gender, tumor stage and the like.While in animals, the most preferable way of determining the MTD can beanalogous to that shown in the Examples presented below, in humans theMTD may generally be determined by starting with one singleadministration of a very low dose, e.g. 1/10th of the LD₁₀ (i.e., thedose that is lethal to 10% of animals) in the most sensitive animalspecies in which toxicology studies have been performed, e.g. forepothilones (especially epothilone B) in the range from 0.1 to 25 mg/m²,especially for epothilone B in the range from 0.1 to 2.5 mg/m², mostespecially in the range of 0.1 to 0.33 mg/m². Dose escalation for thenext dose level is 100%, unless grade 2 toxicity is seen according tothe US National Cancer Institute Revised Common Toxicity Criteria, inwhich case dose escalation will be 67%. Dose escalation for subsequentdose levels is in the range of 25% to 67%. For example, three patientsare usually treated at one dose level and observed for acute toxicityfor one course of treatment before any more patients are entered. Ifnone of the three patients experience DLT (dose-limiting toxicity), thenthe next cohort of three patients is treated with the next higher dose.If two or more of the three patients experience DLT, then three morepatients are treated at the next lower dose unless six patients havealready been treated at that dose. If one of three patients treated at adose experiences DLT, then three more patients are treated at the samelevel. If the incidence of DLT among those patients is one in six, thenthe next cohort is treated at the next higher dose. In general, if twoor more of the six patients treated at a dose level experience DLT, thenthe MTD is considered to have been exceeded, and three more patients aretreated at the next lower dose as described above. The MTD is defined asthe highest dose studied for which the incidence of DLT was less than33%. Usually dose escalation for subsequent courses in the samepatient—i.e. intrapatient dose escalation—is not permitted.Alternatively, dose steps may be defined by a modified Fibonacci seriesin which the increments of dose for succeeding levels beyond thestarting dose are 100%, 67%, 50% and 40%, followed by 33% for allsubsequent levels. Finally, the MTD may be found by methods described inSimon, R., et al., J. Nat. Cancer lnst. 89(15), 1997, p. 1138-1147.

The DLT generally includes (but is not limited to) any drug-relateddeath and most drug-related grade 3 and 4 toxicities, including febrileneutropenia (see also US National Cancer Institute Revised CommonToxicity Criteria). See especially the examples. For a human, thepreferred treatment doses are defined by formula I, more preferablyformula II, most preferably formula III mentioned above (with theproviso that no single dose is higher than 18 mg/m². Preferably, forweekly treatment the dose is between about 0.1 and about 6, preferablyabout 0.1 and about 5 mg/m², more preferably about 0.1 and about 3mg/m², even more preferably about 0.1 and about 1.7 mg/m², mostpreferably about 0.3 and about 1 mg/m²; for three-weekly treatment(treatment every third week) the dose is between about 0.3 and about 18mg/m², preferably about 0.3 and about 15 mg/m², more preferably about0.3 and about 12 mg/m², even more preferably about 0.3 and about 7.5mg/m², still more preferably about 0.3 and about 5 mg/m², mostpreferably about 1.0 and about 3.0 mg/m². This dose is preferablyadministered to the human by intravenous (i.v.) administration during 2to 180 min, preferably 2 to 120 min, preferably during about 5 to about30 min, most preferably during about 10 to about 30 min, e.g. about 30min.

From the use of animal data, the applicable doses in (adult) humans maybe roughly calculated as follows:

-   -   A dose of 1 mg/kg in mouse corresponds to a dose of 3 mg/m² in a        human.

By sufficient recovery from the preceding treatment, in warm-bloodedanimals there is meant especially the regain of body weight of thetreated individual to the starting level found before the first dosing,preferably to at least 95% of said weight. In a human, the recovery fromeach preceding dose administration is preferably defined as recoveryfrom any grade 3 or 4 toxicity, including e.g. achievement of a plateletcount of at least 100,000/mm³ and a neutrophil count of at least 1,500cells/mm³ whole blood.

Treatment can be repeated if no response is achieved after a firsttreatment, until tumor progression is found or until other reasons (e.g.the condition of the patient) require termination of treatment. In ahuman, the treatment with about 25 to about 100% of the MTD ispreferably repeated every 1 to ten, especially 2 to ten weeks;preferably every 1 to 10 weeks, or every 3 to 6 weeks, until diseaseprogression, unacceptable toxicity, 1 or preferably 2 cycles beyonddetermination of a complete response, or patient withdrawal of consentfor any reason is encountered.

Preferably, in the case of weekly treatment of a human with epothilone,the dose is in the range of about 5 to about 60%, preferably about 10 toabout 60%, e.g. about 5 to about 35% of the MTD, especially in the rangeof about 30 to about 35% of the MTD. Preferably, for epothilone B thedose is in the range of about 5 to about 60%, more preferably about 10to about 60%, especially in the range of about 10 to about 45%, mostespecially in the range of about 30 to about 45% of the three-weeklyMTD.

More preferably, treatment is stopped after the third to eighth,especially after the third to fifth weekly administration followed by arest period of two to five, e.g. two weeks before further treatment isresumed, either by single or again weekly or twice weeklyadministration. Especially, in the case of weekly epothilone B treatmentis stopped after the third to eighth administration followed by a restperiod of two to four, e.g. two weeks before treatment is resumed byweekly administration.

Administration of component (a), that is epothilones A and/or B,especially B, takes place preferably as described above, especiallyusing one of the special treatment regimens mentioned above.

Administration of component (b) preferably takes place according totreatment schedules that are known to the person skilled in the art.

In one preferred embodiment, component (b) is administered beforecomponent (a), preferably in a treatment comprising one or moreadministrations of component (b) before starting the treatment withcomponent (a), preferably such that treatment with component (b) ends atleast two, preferably 5 to 10, e.g. about 5, days prior to treatmentwith component (a) that is administered one or more times thereafter,preferably one to five, especially one or two times.

In a more preferred embodiment, component (a) is administered on a3-weekly schedule before component (b), preferably in a treatmentcomprising one administration of component (a) before starting thetreatment with component (b), more preferably such that treatment withcomponent (a) ends immediately prior to treatment with component (b)that is administered thereafter.

In a second more preferred embodiment, component (a) is administered ona weekly schedule. Component (b), on the other hand, is administered ona 3-weekly schedule, with each administration proceeding immediatelyupon completion of every third administration of component (a).

In a third more preferred embodiment, component (a) is administered on aweekly schedule before component (b), preferably in a treatmentcomprising one administration of component (a) before starting treatmentwith component (b), more preferably such that treatment with component(a) ends immediately prior to treatment with component (b) that isadministered thereafter.

By the term “other chemotherapeutic agent” there is meant especially anychemotherapeutic agent that is or can be used in the treatment of tumordiseases, such as chemotherapeutics derived from the following classes:

(A) Alkylating agents, preferably cross-linking chemotherapeutics,preferably bis-alkylating agents,

(B) antitumor antibiotics, preferably doxorubicin (ADRIAMYCIN®, RUBEX®);

(C) antimetabolites;

(D) plant alkaloids;

(E) hormonal agents and antagonists,

(F) biological response modifiers, preferably lymphokines or interferons

(G) inhibitors of protein tyrosine kinases and/or serine/threoninekinases,;

(H) antisense oligonucleotides or oligonucleotide derivatives; or

(I) miscellaneous agents or agents with other or unknown mechanism ofaction.

By the term “jointly therapeutically effective against a proliferativedisease that can be treated ted by administration of epothilone A and/orepothilone B, especially epothilone B”, there is preferably meant aproliferative disease as mentioned above, especially a tumor disease,the response preferably manifesting itself in a diminishedproliferation, e.g. diminished tumor growth or even (more preferably)tumor regression or (most preferably) tumor disappearance (“completeresponse”).

Preferably, the term “quantity which is jointly therapeuticallyeffective against a proliferative disease that can be treated byadministration of epothilone A and/or epothilone B, especiallyepothilone B” means any quantity of the components (a) and (b) of thecombinations that, in the combination, is diminishing proliferation ofcells responsible for any of the mentioned proliferative diseases,especially tumor (including metastatic) cells (especially diminishedtumor growth) or, preferably, even causing regression, more preferablyeven the partial or complete disappearance, of such cells (especiallytumor regression, preferably complete response meaning disappearance ofthe tumor(s)). This term not only comprises combinations of anycomponent (a) and (b) where (a) and (b) are dosed in such a manner as tobe antiproliferatively effective already without combination, but alsodoses of any such component which alone would show no or only marginaleffect but which in combination leads to clearly antiproliferativeeffects, that is to diminished proliferation or preferably even toregression of the proliferating cells or even to cure from theproliferative disease. In addition, here the term “combination” is notonly used to describe fixed combinations of the components, but also anycombination of components (a) and (b) for simultaneous orchronologically staggered use within a period of time which is smallenough for the active compounds both of component (a) and of component(b) to mutually enhance antiproliferative activity, e.g. in a patient.

By the term “combination preparation comprising component (a) and (b)”there is meant any combination, be it as kit of parts or as a singlecombined combination, of component (a) and (b) in the form of apharmaceutical product, that is preferably where a pharmaceuticallyacceptable carrier material is present. For the preferred carriermaterials, see below under “Pharmaceutical Preparations”.

By the term “a product which comprises component (a) and component (b)”,there is preferably meant a product that comprises

(a) at least one compound selected from epothilone A and (preferably)epothilone B and

(b) at least one other chemotherapeutic agent

in the presence or absence of one or more pharmaceutically acceptablecarrier materials, as a combination preparation, for simultaneous orchronologically staggered use, preferably within a period of time whichis small enough for the active compounds both of component (a) and ofcomponent (b) to mutually enhance antiproliferative activity againstproliferating cells, especially in a patient, for treating aproliferative disease which responds to such active compounds”,especially a “kit of parts” in the sense that the effective components(a) and (b) of the combination can be dosed independently or by use ofdifferent fixed combinations with distinguished amounts of anycomponents (a) and (b) at different time points. The “parts” of the kitof parts can then be administered simultaneously or chronologicallystaggered, that is at different time points and with equal or differenttime intervals for any part of the kit of parts, preferably with thecondition that the time intervals are chosen such that the effect on theproliferative disease in the combined use of the parts is larger thanthe effect which would be obtained by use of only any one of component(a) and (b) alone or by use of both in a way that the compounds actindependently (e.g. with long enough periods to avoid effects of each ofthe components on the others), that is, stronger inhibition ofproliferation or, preferably, stronger regression or even cure of theproliferative disease is found than when the same dose of only one ofcomponents (a) and (b) is administered alone in the same dose or aftersufficiently long time intervals that mutual effects of the components(a) and (b) are excluded. That is meant by the term “to mutually enhanceantiproliferative activity against proliferating cells, especially in apatient”; preferably, there is meant a mutual enhancement of the effectof the components (a) and (b), especially a synergism and/or the causingof regression of the proliferating cells, up to and including theircomplete destruction, and especially a strong synergism betweencomponents (a) and (b).

By the term “proliferating cells”, especially pathologically orabnormally proliferating cells are meant, such as tumor and/or tumormettasasis cells, especially of tumors as defined herein as beingpreferred.

Preferred are combinations which show enhanced antiproliferativeactivity when compared with the single components alone, especiallycombinations that show synergism (synergistic combinations) orcombinations that lead to regression of proliferative tissues and/orcure from proliferative diseases.

The term “synergism” is standing for an effect that is stronger thanadditive, that is, a stronger effect of the combination of any component(a) with any component (b) than could be reached by the factor ofdiminuation of proliferation obtained from mere multiplication of thefactor of diminuation of proliferation for any component (a) alone orany component (b) alone when compared to a control without treatmentwhen each (a) and (b) as such, whether alone or in combination, isadministered in the same dose as in the single treatment withoutcombination (which does not mean that the dose of (a) must be identicalto that of (b), although this may also be the case). As theoreticalexample for mere illustration, if a component (a) alone gives a growthof tumor cells that is diminished by a factor of 2 in comparison to acontrol without any treatment and a component (b) alone gives adiminuation of growth by a factor of 1.5, then an additive effect wouldbe one where, by combined use of component (a) and component (b), a3-fold diminuation of growth would be found (multiplication of 2 with1.5). A synergistic effect would for example be present if a more than3-fold diminuation of proliferation is found. The presence of synergismcan be shown by this fractional product method [Webb, in: “Enzymes andMetabolic Inhibitors”, Vol. 1, 66-73 and 488-512, Academic Press, NewYork] or alternatively by the isobologram method [see references in:Berenbaum Pharmacol. Rev. 41, 99-141 (1984)], and/or the combinationindex (CI) calculation method [Chou et al., Trends Pharmacol. Sci. 4,450-454 (1983); or Chou et al., New Avenues in Developmental CancerChemotherapy; Bristol-Myers Symposium Series, K. R. Harrap and I. A.Connors (eds.), 37-64, New York, Academic Press (1987)].

The term “pharmaceutically acceptable carrier materials” is explainedbelow in the definition of pharmaceutical preparations.

Provided that in the respective molecule salt-forming groups arepresent, component (b) (other chemotherapeutic(s)) may also be presentin the form of salts wherever it is mentioned above or below.

Termination of treatment preferably takes place when either of thefollowing occurs: Disease progression, for example under the SouthwestOncology Group (SWOG) response criteria; unacceptable toxicity (e.g. tothe patient, the investigator, or both); treatment 2 cycles beyonddetermination of a complete response, for example under the SouthwestOncology Group (SWOG) response criteria; or patient withdrawal ofconsent.

Salts of components are especially acid addition salts, salts with basesor, when several salt-forming groups are present, optionally also mixedsalts or internal salts. Salts are especially the pharmaceuticallyacceptable, e.g. substantially non-toxic, salts.

Such salts are formed, for example, from chemotherapeutics having anacidic group, for example a carboxy, phosphodiester or phosphorothioategroup, and are, for example, their salts with suitable bases, such asnon-toxic metal salts derived from metals of groups Ia, Ib, IIa and IIbof the Periodic Table of Elements, especially suitable alkali metalsalts, for example lithium, sodium or potassium salts, or ammoniumsalts, also those salts that are formed with organic amines, such asunsubstituted or hydroxy-substituted mono-, di- or tri-alkylamines,especially mono-, di- or tri-lower alkylamines, or with quaternaryammonium compounds, for example with N-methyl-N-ethylamine,diethylamine, triethylamine, mono-, bis- or tris-(2-hydroxy-loweralkyl)amines, such as mono-, bis- or tris-(2-hydroxyethyl)amine,2-hydroxy-tert-butylamine or tris(hydroxymethyl)methylamine,N,N-di-lower alkyl-N-(hydroxy-lower alkyl)-amines, such asN,N-dimethyl-N-(2-hydroxyethyl)-amine or tri-(2-hydroxyethyl)-amine, orN-methyl-D-glucamine, or quaternary ammonium salts, such astetrabutylammonium salts. The chemotherapeutics having a basic group,for example an amino or imino group, can form acid addition salts, forexample with inorganic acids, for example a hydrohalic acid, such ashydrochloric acid, sulfuric acid or phosphoric acid, or with organiccarboxylic, sulfonic, sulfo or phospho acids or N-substituted sulfamicacids, such as, for example, acetic acid, propionic acid, glycolic acid,succinic acid, maleic acid, hydroxymaleic acid, methylmaleic acid,fumaric acid, malic acid, tartaric acid, gluconic acid, citric acid, orbenzoic acid, also with amino acids, for example, α-amino acids, andalso with methanesulfonic acid, ethanesulfonic acid,2-hydroxyethanesulfonic acid, ethane-1,2-disulfonic acid,benzenesulfonic acid, 4-methylbenzenesulfonic acid,naphthalene-2-sulfonic acid, N-cyclohexylsulfamic acid (with formationof the cyclamates) or with other acidic organic compounds, such asascorbic acid. Compounds having acidic and basic groups can also forminternal salts. If more than one salt-forming group is present, it isalso possible that mixed salts are present.

Where hereinbefore and hereinafter numerical terms are used, they aremeant to include the numbers representing the upper and lower limits.For example, “between 1 and 3” stands for a range “from and including 1up to and including 3”, and “in the range from 1 to 3” would stand for“from and including 1 up to and including 3”. The same is true whereinstead of numbers (e.g. 3) words denoting numbers are used (e.g.“three”).

Where “comprising” is used, this can preferably be replaced by“consisting essentially of”, more preferably by “consisting of”.

Where “about” is used in connection with a number, this preferably meansthe number ±15%, more preferably the number plus 5%, most preferably thenumber itself without “about”. For example, “about 100” would stand for“from and including 85 to and including 115”. Where “about” is used inconnection with numeric ranges, for example “about 1 to about 3”, or“between about one and about three”, preferably the definition of“about” given for a number in the last sentence is applied to eachnumber defining the start and the end of a range separately. Preferably,where “about” is used in connection with any numerical values, the“about” can be deleted.

“Weekly” stands for “about once a week” (meaning that more than onetreatment is made with an interval of about one week betweentreatments), the about here preferably meaning ±1 day (that is,translating into “every 6 to 8 days”); most preferably, “weekly” standsfor “once every 7 days”.

“3-weekly” or “three-weekly” stands for “about once every three weeks”(meaning that more than one treatment is made with an interval of aboutthree weeks between treatments), the about here preferably meaning ±3days (that is, translating into every 18 to 24 days); most preferably,“weekly” stands for “once every 21 days” (=every third week).

PREFERRED EMBODIMENTS OF THE INVENTION

In the following preferred embodiments of the invention, the generaldefinitions may be replaced by the more specific definitions givenhereinbefore and hereinafter, as appropriate.

(1) The present invention relates especially to the treatment of aproliferative disease, especially a cancer, especially a cancer that isrefractory to treatment with other chemotherapeutics and/or a member ofthe taxane class of anti-cancer agents, especially TAXOL®, moreespecially one of the preferred diseases as defined above or below,characterized in that an epothilone, especially epothilone A or mostespecially epothilone B, is administered more than once with a weekly upto three-weekly interval to a human in a dose that is calculatedaccording to the formula (I)single dose (mg/m²)=(0.1 to y)×N   (I)where N (a whole or fractional number) is the number of weeks betweentreatments (about one to about three weeks), that is N is about 1 toabout 3; more preferably, the treatment dose is calculated according tothe formula IIsingle dose (mg/m²)=(0.1 to 2.5)×N;   (II);even more preferably according to the formula III,single dose (mg/m²)=(0.1 to 1.7)×N;   (III);or still more preferably according to the formula IVsingle dose (mg/m²)=(0.1 to 1)×N   (IV)where, in each of formulae II to IV, N is about 1 to about 3(corresponding to intervals of about 1 to about 3 weeks betweentreatments);

the epothilone, especially epothilone B, administration preferablytaking place

-   -   (a) weekly in a human in a dose that lies between about 0.1 and        about 6, preferably about 0.1 and about 5 mg/m², more preferably        about 0.1 and about 3 mg/m², even more preferably about 0.1 and        about 1.7 mg/m², most preferably about 0.3 and about 1 mg/m²; or    -   (b) three-weekly in a human in a dose that lies dose is between        about 0.3 and about 18 mg/m², preferably about 0.3 and about 15        mg/m² more preferably about 0.3 and about 12 mg/m², even more        preferably about 0.3 and about 7.5 mg/m², still more preferably        about 0.3 and about 5 mg/m², most preferably about 1.0 and about        3.0 mg/m²;

the administration preferably taking place by i.v. infusion during 2 to120 min, more preferably during about 5 to about 30 min, most preferablyduring about 10 to about 30 min, e.g. during about 30 min.

(2) The present invention preferably relates also to the treatment of atumor disease that is refractory to the treatment with an otherchemotherapeutic, especially selected from 5-fluorouracil and preferablya microtubule stabilizing agent of the taxane class, most especiallyTAXOL®, said tumor being selected from a gastrointestinal, e.g.colorectal; a renal; a genitourinary, e.g. prostatic; a pancreatic; anda brain tumor (and/or any metastasis thereof), most preferably agastrointestinal tumor, especially a colorectal cancer, more especiallya gastrointestinal cancer, especially a colorectal cancer, that isrefractory to treatment with a member of the taxane class of anti-canceragents, especially TAXOL®, or very especially such tumor that isrefractory to a standard chemotherapy, such as treatment a standardchemotherapeutic, especially with 5-fluorouracil; or a tumor of thegenitourinary tract, especially a prostate cancer, most especially ahormone-refractory prostate cancer; where epothilone A and/or B,especially epothilone B, is administered to a warm-blooded animal,especially a human.

(3) The present invention preferably also relates to the treatment of atumor disease, especially a lung tumor, especially a non-small cell lungcarcinoma, especially such lung cancer that is refractory to treatmentwith a member of the taxane class of anti-cancer agents, especiallyTAXOL®; a breast tumor, especially one that is multidrug resistant; oran epidermoid tumor, preferably an epidermoid head and neck, especiallymouth, tumor, especially if the latter is multidrug resistant and/orresistant to treatment with a member of the taxane class of anti-canceragents, in particular TAXOL®; where epothilone A and/or B, especiallyepothilone B, is administered to a warm-blooded animal, especially ahuman.

(4) The present invention also preferably relates to an in vivo regimenfor the treatment of a tumor disease, especially (i) of a tumor of thegastrointestinal tract, most especially a tumor of the colon and/orrectum (colorectal tumor); and/or (ii) a tumor of the genitourinarytract, especially a prostate tumor (preferably a hormone-refractoryprostate tumor); especially where such tumor is refractory to treatmentwith an other chemotherapeutic, especially one of the taxane class, mostespecially TAXOL®; where epothilone A and/or B, especially epothilone B,is administered once in a dose that is between about 20 and about 100%of the MTD, to a human; and, if required, one or more (preferably two toseven) further doses each within the dose range mentioned above for thefirst dose are administered in further treatment cycles, preferably eachdose after a period of time that allows for sufficient recovery of thetreated individual from each preceding dose administration, especiallymore than two weeks after the preceding treatment, more especially twoto 10 weeks, most especially three to six weeks after the precedingtreatment, especially three weeks after that treatment.

More preferably, under (1) to (4) epothilone B is administered weekly toa human in a dose that lies between about 0.1 and about 6, preferablyabout 0.1 and about 5 mg/m², more preferably about 0.1 and about 3mg/m², even more preferably about 0.1 and about 1.7 mg/m², mostpreferably about 0.3 and about 1 mg/m²; or epothilone B is administeredthree-weekly (every 3 weeks) in a dose that is between about 0.3 andabout 18 mg/m², preferably about 0.3 and about 15 mg/m², more preferablyabout 0.3 and about 12 mg/m², even more preferably about 0.3 and about7.5 mg/m², still more preferably about 0.3 and about 5 mg/m², mostpreferably about 1.0 and about 3.0 mg/m². This dose is preferablyadministered to the human by intravenous (i.v.) administration during 2to 120 min, more preferably during about 5 to about 30 min, mostpreferably during about 10 to about 30 min, e.g. during about 30 min.

More preferably, said treatment is repeated every about 1 to about 3weeks, until disease progression, unacceptable toxicity, 1 or preferably2 cycles beyond determination of a complete response, or patientwithdrawal of consent for any reason is encountered.

(5) The present invention preferably also relates to an in vivo regimenfor the treatment of a tumor disease, especially (i) of a tumor of thegastrointestinal tract, most especially a tumor of the colon and/orrectum (colorectal tumor); and/or (ii) a tumor of the genitourinarytract, especially a prostate tumor; especially where such tumor isrefractory to treatment with an other chemotherapeutic, especially oneof the taxane class, most especially TAXOL® (preferably ahormone-refractory prostate tumor); where epothilone A and/or B,especially epothilone B, is administered weekly to a warm-blooded animalin a dose that is below 80%, more preferably below 50% of the maximaltolerable dose (MTD).

Preferably, in the case of weekly treatment of a human with saidepothilone(s), the dose is in the range of about 1 to about 60%,preferably about 10 to about 60%, e.g. about 5 to about 35% of the MTD,for example. in the range of about 30 to about 35% of the MTD.Preferably, for epothilone B the dose is in the range of about 5 toabout 60%, preferably about 10 to about 60%, especially in the range ofabout 10 to about 45%, most especially in the range of about 30 to about45% of the three-weekly MTD. of the three-weekly MTD. In a special case,the dose can be between about 2 and about 18 mg/m² for epothilone B.

More preferably, treatment is stopped after the third to eighth,especially after the third to fifth weekly administration followed by arest period of two to five, e.g. two weeks before further treatment isresumed. Preferably and if required, in the case of weekly epothilone Badministration treatment is stopped after the third to eighthadministration followed by a rest period of two to four, e.g. two weeksbefore treatment is resumed by weekly administration.

(6) The invention preferably also relates to the in vivo treatment of atumor disease by combined administration (a) of epothilone A and/orepothilone B, especially epothilone B, in combination with (b) an otherchemotherapeutic agent selected from the group consisting of

(A) alkylating agents, preferably cross-linking chemotherapeutics,preferably bis-alkylating agents,

(B) antitumor antibiotics, preferably doxorubicin (ADRIAMYCIN®, RUBEX®);

(C) antimetabolites;

(D) plant alkaloids;

(E) hormonal agents and antagonists,

(F) biological response modifiers, preferably lymphokines or interferons

(G) inhibitors of protein tyrosine kinases and/or serine/threoninekinases,;

(H) antisense oligonucleotides or oligonucleotide derivatives; or

(I) miscellaneous agents or agents with other or unknown mechanism ofaction; the combined treatment being timed so that component (a) and (b)are combined for simultaneous or chronologically staggered use within aperiod of time which is small enough for the active compounds both ofcomponent (a) and of component (b) to mutually enhance antiproliferativeactivity, e.g. in a patient.

(7) The invention also relates to a product which comprises component(a) and component (b) as defined under (6) above, in the presence orabsence of one or more pharmaceutically acceptable carrier materials, asa combination preparation for simultaneous or chronologically staggeredadministration to a human within a period of time which is small enoughfor the active compounds both of component (a) and of component (b) tomutually enhance activity against a tumor disease, especially (i) atumor of the gastrointestinal tract, most especially a tumor of thecolon and/or rectum (colorectal tumor); and/or (ii) a tumor of thegenitourinary tract, especially a prostate tumor; especially where suchtumor is refractory to treatment with an other chemotherapeutic,especially one of the taxane class, most especially TAXOL®; for treatingsaid tumor disease.

Under (1) to (7) or the subsequent embodiments of the invention,administration of the epothilone, especially epothilone B, preferablytakes place by infusion, especially by intravenous infusion.

The following are some especially preferred embodiments of theinvention:

A1. The use of an epothilone, especially epothilone A and/or epothiloneB, for the treatment of a proliferative disease that is refractory totreatment with other chemotherapeutics; or the use of said epothilone,especially epothilone B, for the manufacture of a pharmaceuticalpreparation for the treatment of a proliferative disease that isrefractory to the treatment with other chemotherapeutics.

A2. The use according to A1 where the proliferative disease is a tumordisease that is refractory to a microtubule stabilizing agent of thetaxane class, especially TAXOL®.

A3. The use according to any one of A1 to A2 where the proliferativedisease is a colorectal tumor, and/or a metastasis thereof.

A4. The use according to any one of A1 to A2 where the proliferativedisease is a prostatic tumor, and/or a metastasis thereof; especially ahormone-refractory prostate tumor.

B1. The use of an epothilone for the manufacture of a pharmaceuticalpreparation that is appropriate for administration of said epothiloneonce in a dose that is between about 1 and about 100% of the maximaltolerated dose (MTD) in a warm-blooded animal, to said warm-bloodedanimal for the treatment of a proliferative disease that is refractoryto the treatment with other chemotherapeutics.

B2. The use according to B1 where the epothilone is epothilone A and/orepothilone B, preferably epothilone B.

B3. The use according to any one of B1 and B2 where the dose is between25 and 100% of the maximal tolerated dose and the warm-blooded animal isa human.

B4. The use according to any one of B1 to B3 where the dose unit for anadult human is in the range of between about 0.3 and about 18,preferably about 0.3 and about 12, more preferably about 0.3 and about7.5, most preferably about 1.0 and about 3 mg/m² of epothilone B withthree-weekly treatment; or between about 0.1 and about 6, preferablyabout 0.1 to about 5, more preferably about 0.1 and about 3, mostpreferably about 0.3 and about 1 mg/m² for weekly treatment.

B5. The use according to any one of B1 to B4 where the dose is chosen sothat after a period of time that allows for sufficient recovery of thetreated individual from each preceding dose a further dose can beadministered.

B6. The use according to any one of B1 to B5 where the proliferativedisease is a tumor.

B7. The use according to any one of B1 to B6 where the proliferativedisease is a colorectal tumor, and/or a metastasis thereof.

B8. The use according to any one of B1 to B6 where the proliferativedisease is a prostate tumor, and/or a metastasis thereof.

B9. The use according to any one of B1 to B8 where the tumor is one thatis refractory to treatment with a microtubule stabilizing agent of thetaxane, microtubule stabilizing class of agents, especially TAXOL®.

C1. The use of an epothilone, preferably epothilone A and/or epothiloneB, especially epothilone B, for the manufacture of a pharmaceuticalpreparation that is appropriate for administration of said epothiloneonce weekly, where the dose is 80% or less, preferably 50% or less, ofthe MTD.

D1. The use of an epothilone, especially epothilone A and/or epothiloneB, for the manufacture of a pharmaceutical preparation that isappropriate for the combined administration (a) of an epothilone,preferably epothilone A and/or epothilone B, in combination with (b)another antitumor chemotherapeutic to a warm-blooded animal that suffersfrom a proliferative disease that is refractory to the treatment withother chemotherapeutics, especially a colorectal or prostate tumorand/or a metastasis thereof.

E1. A pharmaceutical preparation for the treatment of a proliferativedisease, especially a tumor disease, especially one of thosecharacterized as being preferred above or below, in a human, saidpreparation comprising an epothilone, especially epothilone B, in a doseranging from 1 to 100%, preferably from 25 to 100% of the maximaltolerable dose (MTD), and a pharmaceutically acceptable carrier.

F1. A combination preparation comprising (a) epothilone A or preferablyepothilone B and (b) one or more other antitumor chemotherapeutics, anda pharmaceutically acceptable carrier.

G1. A product which comprises as component (a) epothilone A and/or B,preferably epothilone B, and as component (b) any other antitumorchemotherapeutic, in the presence or absence of one or morepharmaceutically acceptable carrier materials, as a combinationpreparation for simultaneous or chronologically staggered administrationto a warm-blooded animal, especially a human, within a period of timewhich is small enough for the active compounds both of component (a) andof component (b) to mutually enhance antitumor activity in saidwarm-blooded, animal, for treating a proliferative disease.

The invention relates most especially to the treatment of followingtumor/cancer types with epothilone B:

(i) a gastrointestinal, especially a colorectal tumor that is refractoryto a representative of the taxane class of anti-cancer agents, inparticular TAXOL®; or more especially to the treatment with standardchemotherapy, especially with 5-fluorouracil, and/or TAXOL®.

(ii) a tumor of the genitourinary tract, especially a prostate tumor,including primary and especially metastatic tumors; more especially ifrefractory to hormone treatment;

(iii) an epidermoid, more especially epidermoid head and neck, mostespecially epidermoid mouth tumor, especially one of these that isrefractory to treatment with an other chemotherapeutic, especially dueto multi-drug resistance, especially to treatment with a member of thetaxane class of anti-cancer agents, especially TAXOL®;

(iv) a lung tumor, especially a non-small cell lung cancer, that isrefractory to treatment with an other chemotherapeutic, especially dueto (mainly) multi-drug resistance, especially to treatment with a memberof the taxane class of anti-cancer agents, especially TAXOL®; and/or

(v) a breast tumor, especially a breast tumor that is multidrugresistant, more especially one that is refractory to treatment with amember of the taxane class of anti-cancer agents, especially TAXOL®.

Preferably, the invention relates to the treatment of any one of theabove-mentioned tumor types (i) to (v), most preferably to that of (I),(ii), (iv) and (v).

More preferably, the invention relates to the treatment of any of thetumor types mentioned above under (i) to (v), especially to any one ofthem, by treatment with an intravenous infusion of epothilone B over 2to 120 min, preferably during about 5 to about 30 min, more preferablyduring about 10 to about 30 min, most preferably during about 30 min;

said administration being repeated every one to three weeks, preferablyevery one week (weekly) or every three weeks;

where the epothilone B dose preferably is defined by formula 1,single dose (mg/m²)=(0.1 to y)×N   (I)where N (a whole or fractional number) is the number of weeks betweentreatments that lies between about one and about three weeks, that is, Nis about 1 to about 3; and y is 6, preferably 5, more preferably 4.

More preferably, the treatment dose is calculated according to theformula IIsingle dose (mg/m²)=(0.1 to 2.5)×N;   (II);even more preferably according to the formula III,single dose (mg/m²)=(0.1 to 1.7)×N;   (III);or most preferably according to the formula IVsingle dose (mg/m²)=(0.1 to 1)×N   (IV)where, in each of formulae II to IV, N corresponds to about 1 to about 3(standing preferably for weekly up to three-weekly treatment).

More preferably, for weekly treatment the dose is between about 0.1 andabout 6, preferably about 0.1 to about 5 mg/m², more preferably about0.1 and about 3 mg/m², even more preferably about 0.1 and about 1.7mg/m², most preferably about 0.3 and about 1 mg/m²; or for three-weeklytreatment between about 0.3 and about 18 mg/m², preferably about 0.3 andabout 15 mg/m², more preferably about 0.3 and about 12 mg/m², even morepreferably about 0.3 and about 7.5 mg/m², still more preferably about0.3 and about 5 mg/m², most preferably about 1.0 and about 3.0 mg/m².

More preferably, rest periods of more than one week, more preferably oftwo to ten weeks, more preferably three to six weeks after the precedingtreatment may be necessary (especially in the case of weekly treatment)after for example 3, 4, 6, 8, or more cycles, depending on patientcondition, to allow for sufficient recovery from the precedingtreatment.

Especially preferred are also treatment conditions and formulations inanalogy to those mentioned in the Examples.

Pharmaceutical Formulations

The present invention also relates to the use of epothilone A and/or B,especially epothilone. A or preferably epothilone B, for the manufactureof a pharmaceutical formulation for use against a tumor disease asdefined above; or to a pharmaceutical formulation for the treatment ofsaid tumor disease comprising epothilone A and/or B, especiallyepothilone A or preferably epothilone B, and a pharmaceuticallyacceptable carrier.

The invention relates also to pharmaceutical compositions comprisingepothilone A and/or epothilone B, especially epothilone B, for thetreatment of a proliferative disease, especially a tumor disease definedas being preferred above, and to the preparation of pharmaceuticalpreparations for said treatment.

Epothilone A and/or B may be used, for example, for the preparation ofpharmaceutical compositions that comprise an effective amount of theactive ingredient together or in admixture with a significant amount ofinorganic or organic, solid or liquid, pharmaceutically acceptablecarriers.

The invention relates also to a pharmaceutical composition that issuitable for administration to a warm-blooded animal, especially ahuman, for the treatment of a proliferative disease as definedhereinbefore, comprising an amount of epothilone A and/or B, especiallyepothilone B, which is effective for the treatment of said proliferativedisease, together with at least one pharmaceutically acceptable carrier.

The pharmaceutical compositions according to the invention are those forenteral, such as nasal, rectal or oral, or preferably parenteral, suchas intramuscular or intravenous, administration to a warm-blooded animal(human or animal), that comprise an effective dose of thepharmacologically active ingredient, alone or together with asignificant amount of a pharmaceutically acceptable carrier. The dose ofthe active ingredient depends on the species of warm-blooded animal, thebody weight, the age and the individual condition, individualpharmacokinetic data, the disease to be treated and the mode ofadministration; preferably, the dose is one of the preferred doses asdefined above, being accomodated appropriately where pediatric treatmentis intended.

The pharmaceutical compositions comprise from about 0.00002 to about95%, especially (e.g. in the case of infusion dilutions that are readyfor use) of 0.0001 to 0.02%, or (for example in case of infusionconcentrates) from about 0.1% to about 95%, preferably from about 20% toabout 90%, active ingredient (weight by weight, in each case).Pharmaceutical compositions according to the invention may be, forexample, in unit dose form, such as in the form of ampoules, vials,suppositories, dragees, tablets or capsules.

Preferably, the dose is chosen so as to allow for the treatment regimenbased on the MTD mentioned above for single or rare treatment of a tumordisease.

The pharmaceutical compositions of the present invention are prepared ina manner known per se, for example by means of conventional dissolving,lyophilizing, mixing, granulating or confectioning processes.

Solutions of the active ingredient, and also suspensions, and especiallyisotonic aqueous solutions or suspensions, are preferably used, it beingpossible, for example in the case of lyophilized compositions thatcomprise the active ingredient alone or together with a pharmaceuticallyacceptable carrier, for example mannitol, for such solutions orsuspensions to be produced prior to use. The pharmaceutical compositionsmay be sterilized and/or may comprise excipients, for examplepreservatives, stabilizers, wetting and/or emulsifying agents,solubilizers, salts for regulating the osmotic pressure and/or buffers,and are prepared in a manner known per se, for example by means ofconventional dissolving or lyophilizing processes. The said solutions orsuspensions may comprise viscosity-increasing substances, such as sodiumcarboxymethylcellulose, carboxymethylcellulose, dextran,polyvinylpyrrolidone or gelatin.

Suspensions in oil comprise as the oil component the vegetable,synthetic or semi-synthetic oils customary for injection purposes. Theremay be mentioned as such especially liquid fatty acid esters thatcontain as the acid component a long-chained fatty acid having from 8 to22, especially from 12 to 22, carbon atoms, for example lauric acid,tridecylic acid, myristic acid, pentadecylic acid, palmitic acid,margaric acid, stearic acid, arachidic acid, behenic acid orcorresponding unsaturated acids, for example oleic acid, elaidic acid,erucic acid, brasidic acid or linoleic acid, if desired with theaddition of antioxidants, for example vitamin E, β-carotene or3,5-di-tert-butyl-4-hydroxytoluene. The alcohol component of those fattyacid esters has a maximum of 6 carbon atoms and is a mono- orpoly-hydroxy, for example a mono-, di- or tri-hydroxy, alcohol, forexample methanol, ethanol, propanol, butanol or pentanol or the isomersthereof, but especially glycol and glycerol. The following examples offatty acid esters are therefore to be mentioned: ethyl oleate, isopropylmyristate, isopropyl palmitate, “Labrafil M 2375” (polyoxyethyleneglycerol trioleate, Gattefossé, Paris), “Miglyol 812” (triglyceride ofsaturated fatty acids with a chain length of C₈ to C₁₂, Hüls AG,Germany), but especially vegetable oils, such as cottonseed oil, almondoil, olive oil, castor oil, sesame oil, soybean oil and more especiallygroundnut oil.

The injection or infusion compositions are prepared in customary mannerunder sterile conditions; the same applies also to introducing thecompositions into ampoules or vials and sealing the containers.

Preferred is an infusion formulation comprising epothilone A and/orepothilone B, especially epothilone B, and a pharmaceutically acceptableorganic solvent.

The formulation does not require the use of a surfactant. Surfactantssuch as Cremophor may cause allergic reactions and they also can leachplasticizers from standard PVC containers, tubing and the like.Consequently, when they are employed one is required to use specialinfusion apparatus, e.g. nitro-glycerine tubing and non-plastizisedcontainers, such as glass, tubing and the like.

The pharmaceutically acceptable organic solvent used in a formulationaccording to the invention may be chosen from any such organic solventknown in the art. Preferably the solvent is selected from alcohol, e.g.absolute ethanol or ethanol/water mixtures, more preferably 70% ethanol,polyethylene glycol 300, polyethylene glycol 400, polypropylene glycolor N-methylpyrrolidone, most preferably polypropylene glycol or 70%ethanol or especially polyethylene glycol 300.

The Epothilones may preferably be present in the formulation in aconcentration of about 0.1 to about 100 mg/ml, more preferably about 1to about 100 mg/ml, still more preferably about 1 to about 10 mg/ml(especially in infusion concentrates).

Epothilone A and Epothilone B may be used as pure substances or as amixture of Epothilone A and B. Given the greater anti-tumour activity ofEpothilone B it may be employed in a lower concentration than EpothiloneA in the formulation. When used in its pure form it is preferable toemploy a concentration of Epothilone A of 5 to 100 mg/ml, preferably 10to 50 mg/ml, whereas when Epothilone B is used in its pure form it ispreferably employed in a concentration of 0.1 to 10, more preferably 1to 10, still more preferably 1 to 2 mg/ml (this number makes referenceespecially to an infusion concentrate that, before treatment, is dilutedaccordingly, see below).

Such formulations are conveniently stored in vials or ampoules.Typically the vials or ampoules are made from glass, e.g. borosilicateor soda-lime glass. The vials or ampoules may be of any volumeconventional in the art, preferably they are of a size sufficient toaccommodate 0.5 to 5 ml of formulation. The formulation is stable forperiods of storage of up to 12 to 24 months at temperatures of at least2 to 8° C.

Formulations must be diluted in an aqueous medium suitable forintravenous administration before the epothilone can be administered toa patient.

The infusion solution preferably must have the same or essentially thesame osmotic pressure as body fluid. Accordingly, the aqueous mediumpreferably contains an isotonic agent which has the effect of renderingthe osmotic pressure of the infusion solution the same or essentiallythe same as body fluid.

The isotonic agent may be selected from any of those known in the art,e.g. mannitol, dextrose, glucose and sodium chloride. Preferably theisotonic agent is glucose or sodium chloride. The isotonic agents may beused in amounts which impart to the infusion solution the same oressentially the same osmotic pressure as body fluid. The precisequantities needed can be determined by routine experimentation and willdepend upon the composition of the infusion solution and the nature ofthe isotonic agent. Selection of a particular isotonic agent is madehaving regard to the properties of the active agent.

The concentration of isotonic agent in the aqueous medium will dependupon the nature of the particular isotonic agent used. When glucose isused it is preferably used in a concentration of from 1 to 5% w/v, moreparticularly 5% w/v. When the isotonic agent is sodium chloride it ispreferably employed in amounts of up to 1% w/v, in particular 0.9% w/v.

The infusion formulation may be diluted with the aqueous medium. Theamount of aqueous medium employed as a diluent is chosen according tothe desired concentration of Epothilone in the infusion solution.Preferably the infusion solution is made by mixing a vial or ampoule ofinfusion concentrate afore-mentioned with an aqueous medium, making thevolume up to between 20 ml and 200 ml, preferably between about 50 andabout 100 ml, with the aqueous medium.

Infusion solutions may contain other excipients commonly employed informulations to be administered intravenously. Excipients includeantioxidants.

Antioxidants may be employed to protect the epothilone against oxidativedegradation. Antioxidants may be chosen from any of those antioxidantsknown in the art and suitable for intravenous formulations. The amountof antioxidant may be determined by routine experimentation. As analternative to the addition of an antioxidant, or in addition thereto,the antioxidant effect may be achieved by displacing oxygen (air) fromcontact with the infusion solution. This may be conveniently carried outby purging the container holding said infusion solution with an inertgas, e.g. nitrogen.

Infusion solutions may be prepared by mixing an ampoule or vial of theformulation with the aqueous medium, e.g. a 5% w/v glucose solution inWFI or especially 0.9% sodium chloride solution in a suitable container,e.g. an infusion bag or bottle.

The infusion solution, once formed, is preferably used immediately orwithin a short time of being formed, e.g. within 6 hours.

Containers for holding the infusion solutions may be chosen from anyconventional container which is non-reactive with the infusion solution.Glass containers made from those glass types afore-mentioned aresuitable although it may be preferred to use plastics containers, e.g.plastics infusion bags.

Plastics containers may be principally those composed of thermoplasticpolymers. Plastics materials may additionally comprise additives, e.g.plastizisers, fillers, antioxidants, antistatics and other additivesconventional in the art.

Plastics suitable for the present invention should be resistant toelevated temperatures required for thermal sterilisation. Preferredplastics infusion bags are those made from PVC plastics materials knownin the art.

A wide range of container sizes may be employed. When selecting acontainer size, consideration may be paid to the solubility of theepothilone in the aqueous medium and the ease of handling and, ifappropriate, storage of the container.

It is preferred to use containers which can accommodate between about250 to 1000 ml of infusion solution, but preferably about 50 to about120 ml.

Infusion solutions act in a similar fashion to infusion solutions of themicrotubule interacting agent paclitaxel, and are beneficial in treatingconditions for which paclitaxel might be used. For certain tumorsepothilones offer enhanced beneficial effects compared with paclitaxel.

Dosage forms may be conveniently administered intravenously in a dosageof up to 100 mg/m² Epothilone A and up to about 18 mg/m² of EpothiloneB. The exact dosage required and the duration of administration willdepend upon the seriousness of the condition and the rate ofadministration, and it is preferably as defined above. As the dose maybe delivered intravenously, the dose received and the bloodconcentration can be determined accurately on the basis of known in vivoand in vitro techniques.

Pharmaceutical compositions for oral administration can be obtained bycombining the active ingredient with solid carriers, if desiredgranulating a resulting mixture, and processing the mixture, if desiredor necessary, after the addition of appropriate excipients, intotablets, dragëe cores or capsules. It is also possible for them to beincorporated into plastics carriers that allow the active ingredients todiffuse or be released in measured amounts.

Suitable pharmaceutically acceptable carriers are especially fillers,such as sugars, for example lactose, saccharose, mannitol or sorbitol,cellulose preparations and/or calcium phosphates, for example tricalciumphosphate or calcium hydrogen phosphate, and binders, such as starchpastes using for example corn, wheat, rice or potato starch, gelatin,tragacanth, methylcellulose, hydroxypropylmethylcellulose, sodiumcarboxymethylcellulose and/or polyvinylpyrrolidone, and/or, if desired,disintegrators, such as the above-mentioned starches, also carboxymethylstarch, crosslinked polyvinylpyrrolidone, agar, alginic acid or a saltthereof, such as sodium alginate. Excipients are especially flowconditioners and lubricants, for example silicic acid, talc, stearicacid or salts thereof, such as magnesium or calcium stearate, and/orpolyethylene glycol. Dragëe cores are provided with suitable, optionallyenteric, coatings; there being used, inter alia, concentrated sugarsolutions which may comprise gum arabic, talc, polyvinylpyrrolidone,polyethylene glycol and/or titanium dioxide, or coating solutions insuitable organic solvents, or, for the preparation of enteric coatings,solutions of suitable cellulose preparations, such as ethylcellulosephthalate or hydroxypropylmethylcellulose phthalate. Capsules aredry-filled capsules made of gelatin and soft sealed capsules made ofgelatin and a plastiziser, such as glycerol or sorbitol. The dry-filledcapsules may comprise the active ingredient in the form of granules, forexample with fillers, such as lactose, binders, such as starches, and/orglidants, such as talc or magnesium stearate, and if desired withstabilizers. In soft capsules the active ingredient is preferablydissolved or suspended in suitable oily excipients, such as fatty oils,paraffin oil or liquid polyethylene glycols, and also stabilizers and/orantibacterial agents may be added. Dyes or pigments may be added to thetablets or dragëe coatings or the capsule casings, for example foridentification purposes or to indicate different doses of activeingredient.

In the case of combinations with an other chemotherapeutic, a fixedcombination of two or more components (a) and (b) as defined above ortwo or more independent formulations (e.g. in a kit of part) areprepared as described above, or the other chemotherapeutic(s) is/areused in standard formulations that are marketed and known to the personof skill in the art.

EXAMPLES

The following Examples are intended to illustrate the present inventionbut are not intended to limit the scope thereof. Especially the celllines mentioned therein are not thought to limit the scope of theinvention as they are merely representatives and may be replaced withdifferent cell lines and tumor cells for which they are representatives.

Preparation of Compound Solutions

A stock solution of epothilone B at 10 mg/ml in DMSO is prepared andstored at −20° C. Aliquots are diluted in aqueous solutions to a finalconcentration of 5% v/v DMSO, 0.05% v/v Tween 80(polyoxyethylen-sorbitan-monooleate; ICI Americas, Inc.), and 95% v/vphysiological saline (0.9% w/v NaCl).

Cells and Cell Culture Conditions

Human colorectal adenocarcinoma cell line HCT-15 (ATCC CCL 225) is fromthe American Type Culture Collection (Rockville, Md., USA), and thecells are cultivated in vitro as recommended by the supplier. HCT-15 isan epithelial-like cell line. (Cancer Res. 39: 1020-25 [1979]) that ismulti-drug resistant by virtue of over-expression of P-glycoprotein(P-gp, gp170, MDR-1;Anticancer Res. 11: 1309-12 [1991]; J. Biol. Chem.264: 18031-40 [1989]; Int. J. Cancer 1991; 49: 696-703 [1991]) andglutathione-dependent resistance mechanisms (Int. J. Cancer 1991; 49:688-95 [1991]).

The Colo 205 cell line is also a human colon carcinoma cell line (ATCCNo. CCL 222; see also Cancer Res. 38, 1345-55 [1978] which was isolatedfrom ascitic fluid of a patient, displays epithelial-like morphology andis generally considered to be drug-sensitive.

A human androgen-independent prostate cancer cell line is used toestablish subcutaneous and orthotopic models in mice. The humanmetastatic prostate carcinoma PC-3M is obtained from Dr. I. J. Fidler(MD Anderson Cancer Center, Houston, Tex., USA) and is cultured in Ham'sF12K media supplemented with 7% v/v FBS. The PC-3M cell line is theresult of isolation from liver metastasis produced in nude micesubsequent to intrasplenic injection of PC-3 cells [ATCC CRL 1435;American Type Culture Collection (Rockville, Md., USA)], and they cangrow in Eagle's MEM supplemented with 10% fetal bovine serum, sodiumpyruvate, non-essential amino acids, L-glutamine, a two-fold vitaminsolution (Gibco Laboratories, Long Island, N.Y.) andpenicillin-streptomycin (Flow Laboratories, Rockville, Md.). The PC-3Mcell line is hormone-insensitive (that is, it grows in the absence ofandrogens). The PC-3 cell line is androgen receptor negative, as ispresumably the derived PC-3M cell line. PC-3 is a cell line availablefrom ATCC (ATCC CRL 1435) and corresponds to a grade IV prostaticadenocarcinoma isolated from a 62-year-old Caucasian male; the cellsexhibit low acid phosphatase and testosterone-5-α-reductase activity.The cells are near-triploid with a modal number of 62 chromosomes. Nonormal Y chromosomes can be detected by Q-band analysis.

Human lung adenocarcinoma A549 (ATCC CCL 185; isolated as explantculture from lung carcinoma tissue from a 58-year-old Caucasian male);shows epithelial morphology and can synthesize lecithin with a highpercentage of desaturated fatty acids utilizing the cytidinediphosphocholine pathway; a subtelocentric marker chromosome involvingchromosome 6 and the long arm of chromosome 1 is found in allmetaphases. The human breast carcinoma ZR-75-1 (ATCC CRL 1500; isolatedfrom a malignant ascitic effusion of a 63-year-old Caucasian female withinfiltrating ductal carcinoma); is of mammary epithelial origin; thecells possess receptors for estrogen and other steroid hormones and havea hypertriploid chromosome number.

The human epidermal (mouth) carcinoma cell line KB-8511 (a P-gpover-expressing cell line derived from the epidermoid (mouth) KB-31carcinoma cell line) is obtained from Dr. R. M. Baker, Roswell ParkMemorial Institute (Buffalo, N.Y., USA) (for description see Akiyama etal., Somat. Cell. Mol. Genetics 11, 117-126 (1985) and Fojo A., et al.,Cancer Res. 45, 3002-3007 (1985)) and is cultured as previouslydescribed (Meyer, T., et al., Int. J. Cancer 43 851-856 (1989)). KB-8511cells, like KB-31, are derived from the KB cell line (ATCC) and they arehuman epidermal carcinoma cells; KB-31 cells can be grown in mono-layerusing Dulbecco's modified Eagle's medium (D-MEM) with 10% fetal calfserum (M.A. Bioproducts), L-glutamine (Flow), penicillin (50 units/ml)and streptomycin (50 μg/ml (Flow); they then grow with a doubling timeof 22 h, and their relative plating efficiency is approximately 60%.KS-8511 is a cell line derived from the KB-31 cell line by use ofcolchicine treatment cycles; it shows about a 40-fold relativeresistance against colchicine when compared with the KB-31 cells; it canbe grown under the same conditions as KB-31.

For more details on the characteristics of the cell lines, see the ATCCcatalogue and references cited therein, or the other references citedabove.

The following cell lines mentioned above have been deposited under theBudapest Treaty on Feb. 20, 1998, at the Deutsche Sammlung vonMikroorganismen und Zellkulturen GmbH (DSMZ, Mascheroder Weg 1b, D-38124Braunschweig, Germany) under the following accession numbers,respectively: PC-3M: DSM ACC2338; A-549: DSM ACC2337; KB-8511: DSMACC2342.

In addition, the following cell lines mentioned above have beendeposited under the Budapest Treaty on Dec. 1, 1998, at the DeutscheSammlung von Mikroorganismen und Zellkulturen GmbH (DSMZ, MascheroderWeg 1b, D-38124 Braunschweig, Germany) under the following accessionnumbers, respectively: ZR -75-1: DSM ACC2376; HCT-15: ACC2377.

In the following, general methods are described for the tests made.Where specific conditions are mentioned, these prevail over the generaldescriptions presented in the next paragraphs:

Antiproliferative Assays:

Antiproliferative assays are performed as previously described (Int. J.Cancer 43, 851-6 (1989)). Briefly, cells are seeded at 1.5×10³cells/well into 96-well microtiter plates and incubated overnight.Compounds are added in serial dilutions on day 1. The plates are thenincubated for an additional 2 to 5 days, allowing for at least one celldoubling (cell line dependent), after which the cells are fixed with3.3% v/v glutaraldehyde, washed with water and stained with 0.05% w/vmethylene blue. After washing, the dye is eluted with 3% v/v HCl and theoptical density measured at 665 nm with a SpectraMax 340 (Bucherer,Basel, Switzerland). IC50 values are determined by a computerized system(SoftPro, Bucherer, Basel, Switzerland) using the formula (OD test−ODstart)/(OD control−OD start)×100. IC50 is defined as the drugconcentration which leads to 50% of cells per well compared to controlcultures (100%) at the end of incubation period.

In vivo Antitumor Activity Against s.c. Transplanted Tumors

Female or male BALB/c nu/nu (nude) mice are kept under sterileconditions (10 to 12 mice per Type III cage) with free access to foodand water. Mice weigh between 20 and 25 grams at the time of tumorimplantation. Tumors are established by subcutaneous injection of cells(minimum 2×10⁶ cells in 100 μl PBS or medium) in carrier mice (4-8 miceper cell line). The resulting tumors are serially passaged for a minimumof three consecutive transplantations prior to start of treatment. Tumorfragments (approx. 25 mg) are implanted s.c. into the left flank ofanimals with a 13-gauge trocar needle while the mice are exposed toForene (Abbott, Switzerland) anesthesia.

Tumor growth and body weights are monitored once or twice weekly. Alltreatments are administered intravenously (i.v.) and are initiated whena mean tumor volume of approximately 100 to 250 mm³ is attained,depending upon the tumor type. Tumor volumes are determined using theformula (L×D×π)/6 (see Cancer Chemother. Pharmacol. 24:148-154, [1989]).Treatments with epothilone B vary the dose and the frequency ofadministration. Comparator agents are administered according topreviously determined optimal treatment regimens. In addition topresenting changes in tumor volumes over the course of treatment,antitumor activity is expressed as T/C % (mean increase of tumor volumesof treated animals divided by the mean increase of tumor volumes ofcontrol animals multiplied by 100). Tumor. regression (%) represents thesmallest mean tumor volume compared to the mean tumor volume at thestart of treatment, according to the formula Regression(%)=(1−V_(end)/V_(start))×100(V_(end)=final mean tumor volume,V_(start)=mean tumor volume at the start of treatment. Any animals inwhich the tumor has reached a size exceeding approximately 1.5 to 2.5cm³ are sacrificed. Details can be found below.

In vivo Antitumor Activity Against Orthotopically Injected Cells

Human prostate carcinoma PC-3M cells (1×10⁶ cells per 20 μl phosphatebuffered saline) are injected into the left ventricle of the prostate ofeach animal (n=6-9/group) according the method previously described (seeStephenson et al., J. Natl. Cancer Inst. 84, 951-7 (1992)). Treatment isstarted on day 14 after cell injection. At this time point a mean tumorweight of ˜20 mg is established. Epothilone B is administered eitheronce or once weekly. Mice are sacrificed 42 days post tumor inoculation,and the prostates are carefully removed, dissected free of adheringtissue and weighed. Mesengeal lymph nodes are examined for the presenceof metastases, dissected free of adhering tissue and weighed. Mesentericlymph nodes are examined for the presence of metastases, dissected freeof adhering tissue and weighed.

Tumor weight and body weights are monitored once or twice weekly. Alltreatments are administered intravenously (i.v.) and are initiated 14days post cell injection. Treatment with epothilone B varies the doseand frequency of administration. Antitumor activity is expressed as T/C% (mean tumor weight of treated animals divided by the mean tumor weightof control animals multiplied by 100).

Statistical Analyses

The basic strategy for statistical analyses is to use tests for multiplecomparisons to judge the statistical significance of differences betweentreatment groups, and differences within a group (i.e. comparing to thestart of treatment) to determine if treatment induces stable disease ortumor regressions. As subcutaneous tumor volumes are not normallydistributed, differences in the subcutaneous tumor volumes betweentreatment groups are determined using the non-parametric Kruskal-Wallisone way ANOVA test on ranked data (Rank sum test), and the statisticalsignificance of differences between treatment groups as compared tocontrol groups determined using the Dunnett test. Pair-wise comparisonsbetween all groups is performed using the Student-Newman-Keuls (SNK)method. Organ weights are not always normally distributed and areanalyzed either using non-parametric tests (as above) or are transformedto normality (Log [organ weight]) and are analyzed by One-way ANOVAfollowed by the Dunnett test (comparisons to controls) or using Tukey(between group comparisons). Statistical analysis on Δ tumor volumesuses the Kruskal-Wallis one way ANOVA test on ranked data, comparingtreatment groups with vehicle controls by Dunnett's test. Differences inthe body weights between treatment groups with vehicle controls areanalyzed by paired t-tests. Fisher's Exact Test is used to determine thesignificance of differences in mortalities between the groups. For alltests the level of significance is set at p<0.05, but note that forthese small sample sizes, the desired power level of 0.8 is neverobtained. For the orthotopic model, Fisher's exact test is used todetermine whether the ratios of mice bearing metastases are differentbetween treatment groups and controls. Any statistical calculations areperformed using SigmaStat 2.0 (Jandel Scientific).

Material

Epothilone B is purified from cultures of the myxobacterium Sorangiumcellulosum by Biopharmaceuticals Production and Development Department,Novartis Pharma, Basel, Switzerland. TAXOL® (paclitaxel formulated forclinical use) is purchased from Bristol Myers Squibb (USA), paclitaxelfrom Calbiochem (USA), and 5-fluorouracil (Fluoro-uracil®) is from Roche(Switzerland). Cell culture materials are from Integra BioSciences(Wallisellen, Switzerland). Liquid media, fetal bovine serum (FBS) andmedia additives are from Gibco/BRL (Basel, Switzerland). BALB/c nu/nu(nude) mice are from Bomholtgaard (Copenhagen, Denmark) or obtained fromthe Novartis Animal Farm (Sisseln, Switzerland). Normal BALB/c mice arefrom Iffa Credo (France) or obtained from Novartis Animal Farm (Sisseln,Switzerland).

Determination of the Maximal Tolerated Dose (MTD)

For the MTD determination, female BALB/c nude mice or BALB/c mice(obtained from Novartis Animal Farm, Sisseln, Switzerland) are treatedonce intravenously with epothilone B (n=3 per dose group). The dosage isincreased (2, 4, 6, 8, 10 and 12 mg/kg) and the mice are observed forthe presentation of overt toxic effects for 10 days after drugtreatment.

Example 1 Determination of the Maximal Tolerated Dose (MTD)

The results from the maximal tolerated dose (MTD) study are presented inTable 1 and Table 2. TABLE 1 Determination of the single i.v. dose MTDfor epothilone B in normal female BALB/c mice. Body Weight (mean g ± SD)Dose Δ (p value) % Change Mortalities Experiment 1 12 −5.4 ± 2.9  −23.6± 11.9 3/3 (p = 0.085) 10 −5.6 ± 0.6 −24.9 ± 1.6 3/3 (p = 0.003) 8 −5.1± 3.2  −22.1 ± 13.1 3/3 (p = 0.110) 6 −6.1 ± 0.9 −28.6 ± 3.5 1/3 (p =0.007) Experiment 2 8 −5.0 ± 1.0 −25.3 ± 3.9 3/3 (p = 0.013) 6 −5.3 ±0.6 −27.5 ± 2.1 2/3 (p = 0.004) 4   1.3 ± 0.6    6.5 ± 2.6 0/3 (p =0.057) 2   2.3 ± 0.6   12.3 ± 3.0 0/3 (p = 0.02) Epothilone B is given as a single i.v. bolus dose at 2, 4, 6, 8, 10 or12 mg/kg. Survival and body weights of the mice are monitored daily.Changes (Δ) in body weights are determined comparing the last measuredbody weight to that before treatment.

TABLE 2 Determination of the single i.v. dose MTD for epothilone B infemale BALB/c nude mice. Body Weight (mean g ± SD) Dose Δ (p value) %Change Mortalities 12 −5.1 ± 0.6 −22.9 ± 3.1  3/3 (p = 0.004) 10 −5.6 ±3.3 −23.7 ± 13.6 1/3 (p = 0.336) 8 −3.8 ± 2.7 −16.8 ± 12.2 1/3 (p =0.250) 6 −1.0 ± 0.5 −4.2 ± 2.1 0/3 (p = 0.077) 4 −0.4 ± 0.6 −1.7 ± 2.90/3 (p = 0.427) 2   1.0 ± 0.5   4.2 ± 2.1 0/3 (p = 0.071) 0   0.6 ± 0.6  3.0 ± 2.9 0/3 (p = 0.151)Epothilone B is given as a single i.v. bolus dose at 2, 4, 6, 8, 10 or12 mg/kg. Survival and body weights of the mice are monitored daily.Changes (Δ) in body weights are determined comparing the last measuredbody weight to that before treatment.It follows from these experiments that in normal mice the MTD is around4 mg/kg, while in nude mice the MTD is around 6 mg/kg.

Example 2 Toxicity of Epothilone B (Two-Week Intravenous ComparativeToxicity Study in Mice)

In order to assess the sub-chronic intravenous toxicity of epothilone b,a non-GLP two-week i.v. toxicity study in non-tumor bearing, normalfemale BALB/c mice is conducted, involving analysis of mortality,clinical signs, body weight, food consumption, hematology, clinicalbiochemistry, urinalysis, and organ weights as well as macro andmicroscopic examinations. The study is based on two different dosingregiments of epothilone B of 3 mg/kg and 10 mg/kg, respectively,administered on days 1 and 8 (8 animals per group). Half of the animalsare killed on day 15 (main group) and necropsy is performed. For theother half (recovery group) a recovery period of 5 weeks is allowedafter administration of the second dose before sacrifice and subsequentnecropsy on day 43. However, for the 10 mg/kg dose all animals of therecovery group have to be sacrificed prematurely on day 19, due to poorgeneral condition.

No mortalities occur throughout the treatment period at either doselevel (days 1-14) and for the 3 mg/kg dose group all animals of therecovery group survive until the end of the study. Body weight loss isobserved for all animals in the 10 m/kg dose group during the first andsecond week, whereas body weight loss at the 3 mg/kg dose is onlyapparent in the second week. Body weight development during the recoveryperiod is similar for treated and control animals.

Both dose levels of epothilone B induce a reduction in the number ofleukocytes, especially of neutrophils and lymphocytes, in all treatedanimals (day 15), but the effect is more pronounced at the 10 mg/kgdose. In addition, slight increases in basophil counts as well asdecreased levels of monocytes are observed in some individual animals atboth dose levels. Slightly lower values for red blood cell parameterswith increases in reticulocytes and platelets are recorded only for the10 mg/kg dose. At the end of the recovery period (day 43) hematologicalparameters are normal for two out of the four animals of the 3 mg/kgdose recovery group, whereas the other two still suffer from reducedwhite blood cell counts.

Only minor changes are observed in the clinical chemistry profile oftreated animals, which cannot be clearly related to treatment withepothilone B.

Treatment with epothilone B at both dose levels leads to pronouncedchanges in thymus, spleen, and uterus weights (day 15). In addition,slight reductions in liver weight are observed. (Organ weight isdetermined for adrenal glands, liver, thymus, spleen, brain, ovaries,kidneys, uterus, and heart). For the 3 mg/kg dose, organ weights at theend of the recovery period (day 43) are comparable to those of controlanimals, indicating full recovery. (No organ weights are taken for thesacrificed animals of the 10 mg/kg dose recovery group).

Microscopic investigation of histologically processed selected tissuesfrom animals sacrificed on day 15 reveals moderate to marked atrophy ofthe thymus for the 3 mg/kg and the 10 mg/kg dose, respectively. Inaddition, minimal lymphoid atrophy in the spleen, minimal to slightmyeloid hypoplasia in the sternal bone marrow, and minimally increasedhemopoiesis in the spleen are observed at 10 mg/kg dose. At 3 mg/kg thesternal bone marrow shows minimal to slight erythroid and myeloidatrophy. Minimal single cell necrosis is noted in the intestinal mucosa(small and large intestine) at both dose levels, but with a higherincidence at the 10 mg/kg dose.

Animals from the recovery groups at both dose levels show slight myeloidhyperplasia and/or athropy in the bone marrow. At 10 mg/kg slightlymphoid atrophy is also seen in the spleen and in addition slight tomoderate hemosiderosis is present. There is no thymic tissue availablefor microscopic examination at 10 mg/kg, indicating that thymus atrophymight also have been present in these mice. No histological alterationsin the thymus are found on day 43 for the animals from the 3 mg/kg doserecovery group.

In conclusion, at a dose level of 3 mg/kg (dosing on days 1 and 8)epothilone B is tolerated without mortality for the total observationperiod of 43 days, while animals dosed with 10 mg/kg have to besacrificed on day 19, due to poor health condition. Body weight lossoccurs at both dose levels during the treatment period. Hematologyreveals lower values for leukocytes, neutrophils and lymphocytes withhigher basophil and lower monocyte counts for some individual mice inboth dose groups. In addition, evidence of anemia is seen at both doselevels. No effects on clinical chemistry profile are observed. Moderateto marked atrophy of the thymus are observed at 3 and 10 mg/kg after thetreatment period only (day 15), together with minimal lymphoid atrophyin the spleen at the 10 mg/kg dose. In addition, myeloid hypoplasia inbone marrow and increased hemopoiesis in the spleen are detectable at 10mg/kg. Slight erythroid and myeloid atrophy of bone marrow is seen at3mg/kg. Single cell necrosis is detected in the intestinal mucosa at 3and 10 mg/kg at the end of the treatment period only.

Conclusions

The most important conclusions emerging from the data summarized inExamples 1 and 2 for the toxicological findings with epothilone B can besummarized as follows:

The MTD for single dose i.v. administration of epothilone B to normaland nude mice from a BALB/c background corresponds to 4 mg/kg and 6mg/kg, respectively. Nude mice thus are less sensitive to the toxiceffects of the compound than normal mice.

In normal mice, two doses of 3 mg/kg given one week apart are reasonablywell tolerated and do not cause mortality up to day 43 after the initialdose. The same dosing regimen at a 10 mg/kg dose level results in death(or sacrifice) of all treated animals.

Example 3 In vitro Activity of Epothilones Against Cell Lines

The potent anti-proliferative activity of epothilone B is confirmed forsome human cancer cell lines; the results of these experiments aresummarized in Table 3. Epothilone B generally exhibits higher potencythan paclitaxel, particularly against cancer cells with a multidrugresistant (MDR) phenotype (e.g. KB-8511, HCT-15). TABLE 3 In vitroactivity of the epothilones against human carcinoma cell lines.IC50-values [nM] for growth inhibition of human carcinoma cell lines byepothilone B in comparison to paclitaxel (5 d exposure, mean ± SD, n =3). Values in parenthesis indicate relative resistance, i.e., IC50(resistant line)/IC50 (parental line). Cell Line epothilone B paclitaxelA549 (Lung) 0.19 ± 0.12^(a) 3.75 ± 0.92 ZR-75-1 (Breast) 0.64 ± 0.423.60 ± 1.87 HCT-15 (Colon) 0.41 ± 0.15  106 ± 54 KB-8511 0.89 ± 047^(b) 994 ± 281^(b) (Epidermoid, MDR) (1.25) (343)^(a) PC-3M (Prostate) 3.82± 0.47^(c) 6.74 ± 0.72^(c)^(a)Mean ± SD, n = 2.^(b)2 d Exposure;^(c)3 d exposureMDR = Multidrug Resistant

Example 4 Antitumor Activity of the Epothilones Against Human ColorectalAdenocarcinoma HCT-15 Tumors

Tumor volumes are used as the primary indicator of activity of antitumoragents used alone or in combination, and changes in body weights aremeasured as an indicator of treatment tolerability.

As can be deduced from Table 4, a single 4 mg/kg dose of epothilone B isable to produce tumor regressions (p<0.05 vs. vehicle controls;Dunnett's) in drug-resistant, P-gp over-expressing, HCT-15 colon tumors(FIG. 1 and Table 1). This activity is clearly superior to five 20 mg/kgadministrations of TAXOL® or two 75 mg/kg 5-fluorouracil administrations(p<0.05 vs. epothilone B; SNK test). HCT-15 tumors are resistant to bothTAXOL® and 5-fluorouracil, in that final T/C values of 50% and 88%,respectively, are obtained (both p>0.05 vs. controls; Dunnett's).Epothilone B treatment is well tolerated in that body weight is stableunder treatment; vehicle-treated mice gain weight. No mortalities due totreatment are observed with epothilone B. In contrast, some mortalitiesare observed with TAXOL® treatment (⅛ [12.5%] deaths) and a greaterextent of lethality occurs with 5-fluorouracil ( 4/8 [50%] deaths);however, due to the small size of the treatment groups, this does notreach statistical significance (p>0.05 vs. controls; Fisher's ExactTest). Mice surviving either treatment demonstrate stable body weights.

This result indicates epothilone B produces a pronounced anti-tumoreffect against HCT-15 tumors resistant to TAXOL® and 5-fluorouracil andis well-tolerated at this 4 mg/kg dose. TABLE 4 Antitumor effect ofepothilone B in comparison with TAXOL ® or 5-fluorouracil againstsubcutaneously transplanted human HCT- 15 colon carcinoma in femaleBALB/c nude mice. Tumor Response Host Response Dose, D Tumor D Body %Body Survival Route, Volume Weight Weight (No. Compound Schedule T/CRegression (mm³) (g) Change alive/total) Vehicle 25 ml/kg, 100%  none1939 ± 333 2.1 ± 0.5 10 ± 2  8/8 controls i.v. (p = 0.003) days 14, 16,18, 20 and 22 epothilone B 4 mg/kg, Regression −61%  −97 ± 25 0.4 ± 0.32 ± 2 8/8 i.v. (p < 0.05) (ns) once on day 14 5-fluorouracil 75 mg/kg,88% none 1654 ± 824 2.0 ± 0.7 9 ± 4 4/8 i.v., on (ns) (ns) days 14 and21 TAXOL ® 20 mg/kg, 50% none  963 ± 298 0.7 ± 0.6 3 ± 3 7/8 i.v. (ns)(ns) days 14, 16, 18, 20 and 22Tumor fragments of approximately 25 mg are implanted into the left flankof each female nude mouse (n = 8 per group).Treatments are started on day 14 after tumor transplantation.Epothilone B is administered once at 4 mg/kg, i.v. on day 14.5-Fluorouracil is administered at 75 mg/kg, i.v., on days 14 and 21.TAXOL ® is administered i.v. at 20 mg/kg/day, every second day for 5treatments (days 14, 16, 18, 20 and 22).Antitumor activity is expressed as T/C % (mean increase of tumor volumesof treated animals divided by the mean increase of tumor volumes ofcontrol animals multiplied by 100).Tumor regression (%) represents the final mean tumor volume compares tothe mean tumor volume at the start of treatment.Δ Tumor volumes represent the tumor volume on the last treatment dayminus the tumor volume on the first treatment day.Statistical analyses on Δ tumor volumes uses Dunnett's test to comparetreatment groups to controls.Statistical analyses on body weight changes uses paired t-testscomparing body weights before treatment to those at the end oftreatment; mice weigh ˜20-25 g at the start of treatment.Not significant is indicated by the abbreviation ,,ns”.Data presented are means ± SEM from animals surviving to the end of theexperiment.

Example 5 Antitumor Effect of Epothilone B in Comparison With TAXOL®Against Subcutaneously Transplanted Human KB-8511 Epidermoid Carcinomain Female BALB/c Nude Mice

As can be deduced from Table 5, various regimens of epothilone B areable to inhibit the growth of TAXOL®-resistant KB-8511 tumors in nudemice. A single administration of 4 mg/kg epothilone B produces atransient regression (−51% on day 25 post transplantation; p<0.05 vs.vehicle controls, Dunnett), but the tumors re-grows by day 40post-treatment to result in a final T/C of 24% (p<0.05 vs. vehiclecontrols, Dunnett). This single epothilone B administration is welltolerated producing stable body weights, and no mortalities occur.

Once weekly intravenous administration of epothilone B results indose-dependent inhibition of tumor growth: 4 mg/kg produces 98%regressions (p<0.05 vs. vehicle controls; Dunnett); 2 mg/kg, producestransient 44% regressions and a final T/C of 14% (both p<0.05 vs.vehicle controls; Dunnett); 1 mg/kg produces a final T/C 81% (p >0.05vs. vehicle controls; Dunnett). TAXOL® is inactive against KB-8511tumors (T/C 132%, p>0.05 vs. vehicle controls; Dunnett). At the end ofthe experiment, ⅝ mice treated with 4 mg/kg/week, and ⅛ mice treatedwith 2 mg/kg/week epothilone B have undetectable tumors. Although 4mg/kg once per week tend to reduce body weights (−5±7%), this does notreach statistical significance. Vehicle controls, 2 and 1 mg/kg/weekepothilone B, and TAXOL® groups all display increasing body weights, andthere are no mortalities, suggesting well-tolerated treatments.

These results indicate that epothilone B is effective againstexperimental epidermoid tumors that are TAXOL®-resistant. TABLE 5Antitumor effect of epothilone B in comparison with TAXOL ® againstsubcutaneously transplanted human KB-8511 epidermoid carcinoma in femaleBALB/c nude mice. Tumor Response D Host Response Dose, Tumor D Body %Body Survival Route, Volume Weight Weight (No. Compound Schedule T/CRegression (mm³) (g) Change alive/total) Vehicle 25 ml/kg, 100%  none2001 ± 405 2.6 ± 0.3 12 ± 2 8/8 controls i.v. (p < 0.001) once per weekepothilone B 4 mg/kg, 24% −51%  484 ± 103 0.6 ± 0.6  3 ± 2 8/8 i.v.(transient) (p < 0.05) (ns) once on day 13 epothilone B 4 mg/kg,Regression −98% −107 ± 14 −1.1 ± 0.4   −5 ± 3 8/8 i.v. (p < 0.05) (ns)once per week epothilone B 2 mg/kg, 14% −44%  289 ± 204 1.1 ± 0.4  5 ± 28/8 i.v. (transient) (p < 0.05) (p = 0.031) once per week epothilone B 1mg/kg, 81% none 1620 ± 290 2.6 ± 0.3 12 ± 1 8/8 i.v. (ns) (p = 0.008)once per week TAXOL ® 20 mg/kg 132%  none 2662 ± 509 3.3 ± 0.6 15 ± 38/8 i.v. (ns) (p < 0.001) days 13, 15, 17, 19 and 21Tumor fragments of approximately 25 mg are implanted into the left flankof each female nude mouse (n = 8 per group).Treatments are started on day 13 after tumor transplantation.epothilone B is administered once at 4 mg/kg; i.v. on day 13, or onceper week at 4, 2 or 1 mg/kg, i.v., (on days 13, 21 and 27).TAXOL ® is administered i.v. at 20 mg/kg/day, every second day for 5treatments (days 13, 15, 17, 19 and 21).Antitumor activity is expressed as T/C % (mean increase of tumor volumesof treated animals divided by the mean increase of tumor volumes ofcontrol animals multiplied by 100).Tumor regression (%) represents the final mean tumor volume compared tothe mean tumor volume at the start of treatment.Changes (Δ) in Tumor volumes represent the tumor volume on the lasttreatment day minus the tumor volume on the first treatment day.Statistical analyses on Δ tumor volumes uses Dunnett's test to comparetreatment groups to controls.Statistical analyses on body weight changes use paired t-tests comparingbody weights before treatment to those at the end of treatment; miceweigh ˜20-25 g at the start of treatment.Not significant is indicated by the abbreviation ,,ns”.Data presented are means ± SEM from animals surviving to the end of theexperiment.It follows from the experiment that, while TAXOL ® is not effective,epothilone B treatment shows effective antitumor activity; evenregression can be found at the 4 mg/kg dose.

Example 6 Antitumor Activity of the Epothilones Against OrthotopicallyInjected PC-3M Prostate Cells

The results determining the activity of epothilone B against PC-3Mtumors initially growing in prostate and then forming metastases inmesengeal lymph nodes are presented in Table 6.

In this experimental prostate cancer model, PC-3M cells initially growin the prostate and then form metastases in mesenteric lymph nodes.Organ weights are used to assess antitumor activity of the treatments.

Table 6 represents the progress of the experimental cancer from 14 dayspost cell injection (start of treatment), where no lymph nodeinvolvement is observed, to 42 days post cell injection, where prostateand mesenteric lymph nodes dramatically increase in weight. Alladministration regimens of epothilone B are highly effective (all p<0.05versus controls; Dunnett's test on log transformed data) in reducingprostate weights and preventing metastases of the tumor to themesenteric lymph nodes. All of the active treatments are equivalent inantitumor activity (p>0.05; Dunn's). In each of the epothilone Btreatment groups, only one animal has detectable metastases, as comparedto all animals in the vehicle-treated controls (p<0.05; Fisher's Exacttest), indicating that treatment with epothilone B significantly impairsthe formation of detectable metastases.

Epothilone B treatments are not well-tolerated at the higher doses.Whereas a single administration of 6 mg/kg, or two administrations of 4mg/kg, only tend to reduce body weights, administration of 8 mg/kg once,or 5 mg/kg once weekly, produces significant losses in body weight(Table 6). Treatment appears to promote survival of tumor-bearing mice;however, likely owing to the small numbers per treatment group, thisonly reaches statistical significance with the 6 mg/kg (once) regimen(p=0.029, Fisher's Exact test on final survival numbers).

Epothilone B demonstrates excellent antitumor activity in this model,both in terms of reduction of primary tumors and prevention ofmetastases. However, epothilone B, in some regimens, is poorlytolerated.

The results of this study indicate that epothilone B is active againsthuman prostate carcinomas both in vitro and in vivo (see Example 3).Epothilone B is able to reduce the growth of the primary tumor andpotently inhibit the formation of detectable metastases in an orthotopicmodel of prostate cancer. Furthermore, it may also promote survival ofthese tumor-bearing mice, although this needs to be examined inadditional experiments. In parallel with its potent antitumor activity,epothilone B treatment produces significant body weight losses with thetested dosage regimens. However, the reasons for this poor tolerabilityare unknown.

The activity of epothilone B in the orthotopic PC-3M model is especiallynoteworthy. Orthotopic models are designed to implant the tumor withinthe tissues where the primary tumor is located in humans, and unlikemost subcutaneous tumor implantation models, metastases frequentlyarise. Therefore, the repression of primary tumor growth in the prostateby epothilone B, and the inhibition of the formation and/or growth ofmesenteric lymph node metastases represents a significant activity ofepothilone B.

In summary, owing to potent antitumor activity in experimental prostatecancer models, which are considered relatively resistant to chemotherapy(Br. J. Cancer 75, 1593-600 (1997)), epothilone B appears to be apromising agent for the treatment of prostate cancer. TABLE 6 Antitumoreffect of epothilone B against orthotopically injected human PC-3Mprostate carcinoma cells in male BALB/c nude mice. Tumor Response HostResponse Dose, (T/C %) Δ Body % Body Route Lymph Weight Weight SurvivalCompound Schedule Prostate Nodes (g) Change (No. alive/total) Vehicle 25ml/kg, 100% 100% −1.6 ± 1.8 −5 ± 9 4/9 controls i.v. (ns) onceEpothilone B 8 mg/kg, 1 4 −5.2 ± 4.3 −13 ± 15 7/9 i.v. (p = 0.009) once6 mg/kg, 5 4 −1.4 ± 4.1  −6 ± 12 9/9 i.v. (ns) once 5 mg/kg, 1 4 −6.8 ±1.5 −25 ± 5  7/9 i.v. (p < 0.001) once per week 4 mg/kg, 2 4 −1.2 ± 2.3−1 ± 5 8/9 i.v. (ns) once per week1 × 10⁶ PC-3M cells in 20 μL of PBS are injected into the left ventricleof the prostate of each male nude mouse (n = 9 per group).Treatments are started on day 14 after tumor cell injection.epothilone B is administered i.v., once at 6 or 8 mg/kg, or once perweek at 4 or 5 mg/kg.Antitumor activity is expressed as T/C % (mean tumor weight of treatedanimals divided by the mean of tumor weight of control animalsmultiplied by 100).Differences in body weights consider only animals surviving to the endof the experiment (day 42).Statistical analyses on Δ body weight uses paired t-tests comparing bodyweights before treatment to the end of treatment; mice weigh ˜20-25 g atthe start of treatment.Not significant is indicated by the abbreviation ,,ns”.

Example 7 Effect of Epothilone B Against Human Non-Small Cell LungCarcinoma A549

3-10 million cells are implanted s.c. into the right axillary (lateral)region of outbred athymic (nu/nu) mice, and are allowed to grow until atumor volume of approximately 100 mm³ is established. Epothilone B isformulated in 1% DMSO in 5% glucose in distilled water (D5W), andadministered i.v. either once only, once per week, 3 times per week, or5 times per week. Positive controls are carried out with clinicalformulations of TAXOL® diluted 6 fold with D5W and administered i.v.3×/week.

Antitumor activity is expressed as % T/C (comparing A tumor volumes fortreatment group to vehicle control group) at the end of the experiment.Regressions are calculated using the formula: −(T/T₀−1)×100%, where T isthe tumor volume for the treatment group at the end of the experiment,and T₀ is the tumor volume at the beginning of the experiment.Statistical significance is evaluated using a one-tailed Student'st-test.

Results: Table 7 summarizes results for A549 tumors. Epothilone Binduces significant tumor inhibition (T/C=41%), with no detectabletoxicity, when administered once at 6 mg/kg. A dose of 4 mg/kgadministered 1×/week (4 mg/week) induces tumor stasis (T/C=7%), but alsoproduces a 13% body weight loss. By comparison, at the dose of 1.5 mg/kgadministered 3×/week (4.5 mg/week) all animals have to be euthanatizedin the first week of the experiment due to toxicity. Dosing with 0.5mg/kg, 5×/week (2.5 mg/week) induces tumor inhibition identical to thatof the once only regimen (T/C=41%), but apparent cumulative toxicityresults in a 23% body weight loss. TAXOL®, administered 3×/week at adose of 20 mg/kg, does not inhibit tumor growth, and induces a 16% bodyweight loss, with lethality in 1 of 8 mice. TABLE 7 Antitumor activityof Epothilone B, compared to TAXOL ®, on A549 non small cell lung tumorsin nude mice. Delta Mean Delta % Dose Tumor Vol. Body Dead/ CompoundRegimen (mg/kg) (mm³) % T/C % Regression Weight Total 1% DMSO/ 3x/week —439 — none +8.9 0/7 D5W epothilone B 5x/week 0.5 178 41** none −23.1 0/8epothilone B 3x/week 1.5 NE NE NE NE 8/8 epothilone B 1x/weeks 4  32 7** none −13.2 0/8 epothilone B Once 6 178 41** none +8.5 0/8 TAXOL ®3x/week 20 459 105   none −16.0 1/8 Cremophor ®/ — — 207 ethanol/ D5WTreatments are started on day 16 post implantation (10 millioncells/animal).Epothilone B is administered i.v. once at 6 mg/kg (day 16), once weeklyat 4 mg/kg (days 16, 23, and 30), three times per week at 1.5 mg/kg(days 16, 18, 21, 23, 25, 28, 30, 32, and 35), or five times per week at0.5 mg/kg (days 16-18, 21-25, 28-32, and 35-36).TAXOL ® is administered i.v. three times per week at 20 mg/kg (days 16,18, 21, 23, 25, 28, 30, 32, and 35) as split doses of 10 mg/kg given onehour apart.Vehicle control (1% DMSO/D5W) is administered i.v. three times per week(days 16, 18, 21, 23, 25, 28, 30, 32, and 35).All final data are recorded on day 37.A single asterisk (*) indicates p < 0.05, and a double asterisk (**)indicates p < 0.01, using a one-tailed Student's t-Test.“NE”: not evaluable— animals euthanatized due to compound toxicity.

Example 8 Antitumor Activity of Epothilone B Compared to TAXOL® on A549Non-Small Cell Lung Tumors in Nude Mice

Materials and methods pertaining to the human tumor xenograft model areas previously described. 10 or 1 million cells (A549) are implanted s.c.into the right axillary (lateral) region of outbred athymic (nu/nu)mice, and are allowed to grow until a mass of approximately 100 mm³ isestablished. Epothilone B is formulated in 1% DMSO in 5% glucose indistilled water (D5W), and administered i.v. once weekly for 3 weeks.Positive controls are carried out with clinical formulations of TAXOL®diluted 4 fold with D5W and administered i.v. 3×/week, for 3 weeks, insplit doses (2×10 mg/kg) given 1 hour apart.

Antitumor activity is expressed as % T/C (comparing Δ tumor volumes fortreatment group to vehicle control group) at the end of the experiment.Regressions are calculated using the formula: (T/T₀−1)×100%, where T isthe tumor volume for the treatment group at the end of the experiment,and T₀ is the tumor volume at the beginning of the experiment.Measurements are taken for an additional 2 weeks after completion of theregular 3 weeks experiments, to evaluate reversibility of drug-inducedbody weight loss, and sustainability of antitumor effects. Statisticalsignificance is evaluated using a one-tailed Student's t-test, andDunnett's, or Dunn's tests.

Results Table 8 summarizes results for A549 tumors, for the standard 3weeks experiment. Once weekly administration of epothilone B producesstatistically significant, dose dependent inhibition of tumor growth,approaching tumor stasis at highest concentrations of the drug.Epothilone B produces marked inhibition of tumor growth at 3.5, and 3mg/kg (T/C=15%, and 23%, respectively). Both doses cause comparable, butreversible (see Table 8) body weight loss of approximately 15%. The 2,and 1 mg/kg doses produced 43%, and 74% T/C, that are statisticallysignificant, with no body weight gain at 2 mg/kg, and normal body weightgain at 1 mg/kg. TAXOL®, administered 3×/week at a split dose of 2×10mg/kg, does not inhibit tumor growth, but produces a 19% body weightloss. TABLE 8 Antitumor activity of epothilone B, compared to TAXOL ®,on A549 non-small cell lung tumors in nude mice. Delta Mean Delta % DoseTumor Vol. Body Dead/ Compound (mg/kg) (mm³ ± SEM) % T/C Weight Total 1%DMSO/ — 262 ± 26 — +7.7 0/8 D5W Epothilone B 1 195 ± 21 74^(*,**) +10.80/8 Epothilone B 2 113 ± 21 43*^(,)** +0.9 0/8 Epothilone B 3  60 ± 2223*^(,)** −16.4 0/8 Epothilone B 3.5  40 ± 15 15*^(,)** −14.6 0/8Cremophor ®/ — 207 ± 26 — +8.3 0/8 ethanol/D5W TAXOL ® 20 293 ± 56142    −19.1 0/8Treatments are started on day 13 post implantation (10 millioncells/animal).Epothilone B is administered i.v. once weekly for 3 weeks (days 13, 20,and 27) at doses of 1, 2, 3, and 3.5 mg/kg.TAXOL ® is administered i.v. three times per week for 3 weeks at 20mg/kg (days 14, 17, 19, 21, 24, 26, 28, 31, and 33) as split doses of 10mg/kg given one hour apart.Final data are recorded on day 34.A single asterisk (*) indicates p < 0.05 using a one-tailed Student'st-Test, and a double asterisk (**) indicates p < 0.05 using a Dunnett'sor Dunn's test.Measurements are taken for an additional 2 weeks after completion of theregular 3 weeks experiments, and the final data for week 5 aresummarized in Table 9. The antitumor effect remains unchanged, whileanimal body weights have recovered.T/C values for the 3.5, 3, 2, and 1 mg/kg dose levels of epothilone Bare 12%, 16%, 49% and 72%, respectively, and all groups have normalweight gain. TAXOL ® remains ineffective, and animals show only a 2%weight gain.

TABLE 9 Antitumor activity of epothilone B, compared to TAXOL ®, on A549non small cell lung tumors in nude mice (extended observation). DeltaMean Delta % Dose Tumor Vol. Body Dead/ Compound (mg/kg) (mm³ ± SEM) %T/C Weight Total 1% DMSO/ — 472 ± 81 — +11.8 0/8 D5W Epothilone B 1 339± 24  72 +12.6 0/8 Epothilone B 2 232 ± 39  49* +13.5 0/8 Epothilone B 3 75 ± 25  16*^(,)** +13.2 0/8 Epothilone B 3.5  58 ± 25  12*^(,)** +9.70/8 Cremophor ®/ — 355 ± 80 — +13.0 0/8 ethanol/D5W TAXOL ® 20  509 ±123 144 +1.7 0/8Measurements for the experiment described in Table 1 are extended byadditional two weeks.Final data are recorded on day 48.A single asterisk (*) indicates p < 0.05 using a one-tailed Student'st-Test, and a double asterisk (**) indicates p < 0.05 using a Dunnett'sor Dunn's test.

Example 9 Antitumor Effect of Epothilone B on ZR-75-1 Breast Tumors

Table 10 shows the results of an experiment where the effect of TAXOL®and epothilone B on the breast cancer cell line ZR-75-1 are compared.The methods that are used for this tumor model have been describedabove.

It follows from the data that (judged on antitumor efficiency) the bestdosing schedule is one where 4 mg/kg are administered weekly. However,mortality is observed at all dosages, suggesting that the ZR-75-1 tumormay affect the overall health of the mice in contrast to other tumortypes. TABLE 10 Antitumor effect of epothilone B against subcutaneouslytransplanted human estrogen-dependent ZR-75-1 breast tumors in femaleBALB/c nude mice. Tumor Response Host Response Dose, Δ Tumor Δ Body %Body Survival Route, T/C Volume Weight Weight (No. Compound Schedule (%)Regression (mm³) (g) Change alive/total) Vehicle 25 ml/kg, 100 none 444± 58   0.9 ± 0.4   4 ± 2 6/6 controls i.v. every 7 days Epothilone B 4mg/kg, 46 none 208 ± 86 −1.6 ± 1.1 −7 ± 5 4/6 i.v. every 14 daysEpothilone B 4 mg/kg, 1 −8%  29 ± 16 −1.2 ± 0.6 −5 ± 3 3/6 i.v.(transient) every 7 days Epothilone B 2 mg/kg, 40 none 227 ± 76 −3.5 ±1.6 −14 ± 6  5/6 i.v. every 7 days Epothilone B 1 mg/kg, 86 none  393 ±135   0.3 ± 1.2   2 ± 5 4/6 i.v. every 7 daysTumor fragments of approximately 25 mg are implanted into the left flankof each female nude mouse (n = 6 per group); a subcutaneous estrogenpellet is placed in the opposite flank.Treatments are started on day 19 after tumor transplantation.epothilone B is administered at 1, 2 or 4 mg/kg, i.v., either once perweek (days 19, 26 and 33) or every second week (days 19 and 33).Data presented are from animals surviving to day 47, the last day ofcontrols.Antitumor activity is expressed as T/C % (mean increase of tumor volumesof treated animals divided by the mean increase of tumor volumes ofcontrol animals multiplied by 100).Tumor regression (%) represents the final mean tumor volume compared tothe mean tumor volume at the start of treatment.Changes (Δ) in tumor volume represent the tumor volume on the lasttreatment day minus the tumor volume on the first treatment day.

Example 10 Antitumor Effect of Epothilone B in Comparison With5-Fluorouracil Against subcuntaneously Transplanted Colo 205 ColonTumors

Table 11 shows the effect of epothilone B against subcutaneouslytransplanted Colo 205 tumors, as well as the effect of 5-fluorouracil.In contrast to the treatment of the HCT-15 cell line tumors, wherestandard treatment with 5-fluorouracil or treatment with TAXOL® is noteffective, here the treatment with 5-fluorouracil is still effective,though much less so than with epothilone B.

Together with the data from example 4 where the HCT-15 cells do notrespond to (are refractory to) both TAXOL® and the standard colon cancertreatment with 5-fluorouracil, this shows that epothilone B is indeedappropriate to treat tumors that are refractory to known standardtreatments. On the other hand, it is also more effective where standardtreatments work. A preferred treatment schedule can be deduced which is4 mg/kg every 2 weeks (tumor regression, no dead animals). Thistreatment is even better than that with 5-fluorouracil where noregression is found, but only 4 out of 7 animals survive. TABLE 11Antitumor effect of epothilone B in comparison with 5-fluorouracilagainst subcutaneously transplanted human COLO 205 colon tumors infemale BALB/c nude mice (day 32, four days post last treatment). TumorResponse Host Response Dose, Δ Tumor % Body Survival Route, Volume ΔBody Weight (No. Compound Schedule T/C Regression (mm³) Weight (g)Change alive/total) Vehicle 25 ml/kg, 100% none 380 ± 96 2.7 ± 0.3 11 ±2  7/7 controls i.v. every 7 days Epothilone B 4 mg/kg, Regressions −69%−62 ± 7  −1.1 ± 1.0   −4 ± 4   7/7 i.v. every 14 days Epothilone B 4mg/kg, Regressions −87% −83 ± 7  −4.0 ± 0.2   −18 ± 1    5/7 i.v. every7 days Epothilone B 4 mg/kg, Regressions −66% −58 ± 11 2.0 ± 0.1 9 ± 15/7 i.v. once 5-Fluorouracil 75 mg/kg, 18 none  62 ± 12 2.2 ± 0.4 9 ± 24/7 i.v. every 7 daysTumor fragments of approximately 25 mg are implanted into the left flankof each female nude mouse (n = 7 per group); a subcutaneous estrogenpellet is placed on the opposite flank.Treatments are started on day 14 after tumor transplantation.epothilone B is administered at 4 mg/kg, i.v., either once or once perweek (days 14, 21, 28) or every second week (days 14 and 28).5-fluorouracil is administered i.v. at 75 mg/kg on days 14, 21, 28.Data presented are from animals surviving to day 32, four days after thelast treatments.Antitumor activity is expressed as T/C % (mean increase of tumor volumesof treated animals divided by the mean increase of tumor volumes ofcontrol animals multiplied by 100).Tumor regression (%) represents the final mean tumor volume compared tothe mean tumor volume at the start of treatment.Changes (Δ) in tumor volumes represent the tumor volume on the lasttreatment day minus the tumor volume on the first treatment day.

Example 11 A Phase 1, Dose-Finding Study of Single Agent Epothilone BAdministered Once Every Week to Adult Patients With Advanced SolidTumors

Number of centers 2

Objectives

Primary: To characterize the safety profile, including both acute andcumulative toxicities, and determine the maximum tolerated dose ofsingle agent epothilone B administered by intravenous infusion onceevery week to adult patients with advanced solid tumors who have failedstandard systemic therapy or for whom standard systemic therapy does notexist.

Secondary: 1. To characterize the pharmacokinetics of single agentepothilone B administered by intravenous infusion once every week tothis population of patients; data obtained are used in concert withpharmacodynamic data (e.g. hematologic parameters), to makepharmacokinetic/pharmacodynamic (PK/PD) correlations that help predictsafety and efficacy.

2. To obtain preliminary evidence of antitumor activity of single agentepothilone B administered by intravenous infusion once every week tothis population of patients.

3. To correlate intratumor drug levels between adult patients withadvanced solid tumors receiving single agent epothilone B by intravenousinfusion once every week, to those associated with efficacy inpreclinical models.

4. To gather pharmacogenetic information on tumors on tumor biopsysamples where available and accessible pre- and post-therapy in order toidentify genes that correlate with efficacy and response; this isperformed either by genetic analysis of individual gene expression (e.g.p53, Map4, and mdr1 expression status) or by gene chip technology.

Design This is an open-label, dose-escalation study to assess thesafety, pharmacokinetics, and pharmacodynamics of epothilone Badministered by intravenous infusion once every week to adult patientswith advanced solid tumors who have failed standard systemic therapy orfor whom standard systemic therapy does not exist.

The treatment period consists of up to 24 weekly doses. Patientsexperiencing unacceptable toxicity or disease progression arediscontinued prematurely. Patients achieving a complete or partialresponse, or patients with stable disease at the end of 24 dosescontinue further treatment according to an extension protocol at thediscretion of the investigator and after approval by the sponsor.Eligible patients receive additional cycles until disease progression orunacceptable toxicity.

The standard Phase 1 protocol design of enrolling 3-6 patients percohort to establish the MTD is employed. Dose escalation proceedaccording to a modified Fibonacci scheme and is based on toxicities fromthe first 4 weekly doses for each cohort of patients. The starting doseis 0.1 mg/m², with subsequent doses as follows: 0.2, 0.3, 0.5, 0.7, and0.9 mg/m².

The provisional MTD are defined as the dose level immediately below thatat which dose limiting toxicity (DLT) is observed in at least two out of3-6 patients. The cohort defined as the provisional MTD then enrollsadditional patients to a total of 12 to confirm the MTD through furtherevaluation of the safety, pharmacokinetic, and pharmacodynamic profilesof epothilone B.

All toxicities are defined according to the revised US National CancerInstitute Common Toxicity Criteria. DLTs are defined in the protocol; ingeneral, however, the nature of a DLT is such that it is consideredunacceptable even in the setting of an incurable solid tumor.

Patients

Inclusion Criteria

The following criteria are to be met for inclusion into the study:

1. Male or female patients ≧18 years of age.

2. Histologically documented advanced solid tumor, who have failedstandard systemic therapy and up to 1 additional systemic therapy, orfor whom standard systemic therapy does not exist.

3. At least one measurable, evaluable, or non-evaluable site of diseaseas defined by Southwestern Oncology Group (SWOG) Solid Tumor ResponseCriteria including tumor marker value that is above the institutionalupper limit of normal.

4. Women of childbearing potential must have a negative serum β-HCGpregnancy test prior to the initiation of study drug. Male and femalepatients of reproductive potential must agree to employ an effectivemethod of birth control throughout the study and for up to 3 monthsfollowing discontinuation of study drug.

5. World Health Organization (WHO) Performance Status Score of ≦2.

6. Life expectancy of at least 3 months.

7. Written informed consent obtained prior to any screening procedures.

Exclusion Criteria

Exclusion from the study is required if any of the following apply:

1. Female patients who are pregnant or breast-feeding. Postmenopausalwomen must be amenorrheic for at least 12 months to be considered ofnon-childbearing potential.

2. Patient has a severe and/or uncontrolled medical disease (i.e.,uncontrolled diabetes, congestive heart failure, myocardial infarctionwithin 6 months of study, chronic renal disease, or active uncontrolledinfection);

3. Patient has a known brain metastasis.

4. Patient has an acute or known chronic liver disease (i.e., chronicactive hepatitis, cirrhosis).

5. Patient has a known diagnosis of human immunodeficiency virus (HIV)infection.

6. Patient has received any investigational agent within 30 days priorto study entry.

7. Patient received chemotherapy within 4 weeks (6 weeks fornitrosoureas or mitomycin C) prior to study entry.

8. Patient received prior radiation therapy within 4 weeks prior tostudy entry.

9. Patient previously received radiotherapy to ≧25% of the bone marrow.

10. Patient had a major surgery within 2 weeks prior to study entry.

11. Patient has a history of non-compliance to medical regimens.

12. Patient has impairment of hepatic, renal or hematologic function asdefined by the following laboratory parameters:

-   -   Platelet count <100×10⁹/L    -   Absolute neutrophil count (ANC) <1.5×10⁹/L    -   Serum ALT (SGPT) >2.5×institutional upper limit of normal (IULN)    -   Serum total bilirubin >1.5×IULN    -   Serum creatinine >1.5×IULN

14. Patient is <5 years free of another primary malignancy or, in thecase of non-melanomatous skin cancer and cervical carcinoma in situ, hasactive disease.

Sample size This study requires about 40 patients.

Treatments Epothilone B is supplied in individual 2 ml glass vialsformulated as 1 mg/1 ml of the clear, colorless intravenous concentrate.The substance is formulated in polyethylene glycol 300 (PEG 300) anddiluted with 50 to 100 ml 0.9% Sodium Chloride Injection, USP, toachieve the desired final concentration of the drug for infusion. It isadministered as a single 30-minute intravenous infusion every 7 days.

The starting dose level is 0.1 mg/m². This dose is calculated asone-third of the toxic dose low (TDL) in the most sensitive speciesstudied which, for epothilone B, is the dog. As described above, doseescalation proceeds according to a modified Fibonacci scheme. The studydefines treatment delays, dose reductions, or withdrawal from treatmentfor individuals experiencing hematologic or other toxicities known toresult from epothilone B. Treatment continues to a maximum of 24 weeklydoses unless the patient experiences disease progression or unacceptabletoxicity. At the end of 24 doses, patients who have achieved a completeor partial response and patients who have had stable disease maycontinue further treatment according to an extension protocol at thediscretion of the investigator and after approval by the sponsor.

Safety

Variables The safety of epothilone B is assessed by physical examinationand evaluation of vital signs, clinical laboratory results, adverseevents, and use of concomitant medications. Adverse events are bothelicited and volunteered and are graded using the revised US NationalCancer Institute Expanded Common Toxicity Criteria.

Efficacy

Variables Although this phase 1 study is not designed to detectefficacy, activity is demonstrated as a function of the rate ofobjective tumor response and length of progression-free and overallsurvival. Baseline tumor evaluations include optimal assessment of allmeasurable, evaluable, and nonevaluable disease. Evaluations includephysical examination and chest roentgenogram and, as appropriate,computerized tomogram of the thorax, abdomen and pelvis; sonogram of theabdomen and pelvis; bone scintigram, with bone roentgenogram of allknown osseous lesions; and determination of tumor marker values.Follow-up studies are obtained every 6 weeks and after cessation oftreatment.

Objective status is clinically evaluated using the Novartis guidelines,which are based on the SWOG response criteria. All complete-and partialresponses must be confirmed by a second assessment at least four weekslater. Best tumor response are calculated for each patient using theSWOG response criteria.

Pharmacokinetics The following pharmacokinetic parameters are calculatedand analyzed for cycles 1 and 2: t_(max), C_(max), λ_(Z), t_(1/2), AUC,and R_(A). R_(A)=the ratio of AUCτ_(cycle2)/AUCτ_(cycle1) is evaluatedas an index of accumulation. Preliminary assessment of doseproportionality is based on AUC from the last dose among different dosegroups. PK/PD correlations with observed toxicities (e.g.,hematopoietic) are performed as a predictor of safety.

Pharmacodynamics Tumor biopsy samples are obtained where feasible andaccessible, pre-therapy and after the first cycle of therapy. Thesebiopsy samples are prepared for analysis of their gene expression usinggene chip technology, then separately analyzed for p53 status, MAP4 RNAexpression, and mdr1 RNA expression.

Statistical

methods Patients with treatment-emergent clinical adverse events(especially those with dose-limiting toxicity) or with laboratory, vitalsign, or physical examination abnormalities (newly occurring orworsening from baseline) are identified and the values are flagged. Therate of abnormalities is tabulated by cohort. Objective response rates(including both complete and partial responses) are presented by cohort.Descriptive statistics are used to summarize the basic pharmacokineticparameters by cohort.

Example 12 A Phase 1, Dose-Finding Study of Single Agent EPO906(Epothilone B Administered Once Every Three Weeks to Adult Patients withAdvanced Solid Tumors

No. of Centers: 2

Locations Glasgow, UK, & Newcastle, UK

Objectives

Primary: To characterize the safety profile, including both acute andcumulative toxicities, and determine the maximum tolerated dose ofsingle agent epothilone B administered by intravenous infusion onceevery three weeks to adult patients with advanced solid tumors who havefailed standard systemic therapy or for whom standard systemic therapydoes not exist

Secondary: 1. To characterize the pharmacokinetics of single agentepothilone B administered by intravenous infusion once every three weeksto this population of patients; data obtained are used in concert withpharmacodynamic data to make pharmacokinetic/pharmacodynamic (PK/PD)correlations that help predict safety and efficacy

2. To obtain preliminary evidence of antitumor activity of single agentepothilone B administered by intravenous infusion once every three weeksto this population of patients

3. To correlate intratumor drug levels between adult patients withadvanced solid tumors receiving single agent epothilone B by intravenousinfusion once every three weeks to those associated with efficacy inpreclinical models

4. To gather information on tumors from tumor biopsy samples whereavailable and accessible pre- and post-therapy in order to identifybiological factors that correlate with efficacy and response

Design This is an open-label, dose-escalation study to assess thesafety, pharmacokinetics, and pharmacodynamics of epothilone Badministered by intravenous infusion once every three weeks to adultpatients with advanced solid tumors who have failed standard systemictherapy or for whom standard systemic therapy does not exist.

The treatment period consists of up to six 21-day cycles. Patientsexperiencing unacceptable toxicity or disease progression arediscontinued prematurely. Patients achieving a complete or partialresponse, or patients with stable disease at the end of six cyclescontinue further treatment according to an extension protocol at thediscretion of the investigator and after approval by the sponsor.Eligible patients receive additional cycles until disease progression orunacceptable toxicity are observed.

In the absence of dose-limiting toxicity (DLT), dose escalation proceedsas follows:

1. First dose escalation: 100% dose increase (unless grade 2 toxicity isidentified in first cohort, in which case dose escalation is 25%-67%)

2. Dose escalations following 100% dose increase from first to secondcohort: 67% dose increases until grade 2 toxicity is identified

3. Final dose escalations following identification of grade 2 toxicity:25%-67% dose increases, based on consensus reached among theinvestigators and the sponsor

Dose escalation is based on toxicities from the first cycle for eachcohort of patients. The provisional maximum tolerated dose (MTD) isdefined as the dose level immediately below that at which DLT isobserved in at least two out of 3-6 patients. The cohort defined as theprovisional MTD then enrolls additional patients to a total of 12 toconfirm the MTD through further evaluation of the safety,pharmacokinetic, and pharmacodynamic profiles of epothilone B.

Intrapatient dose escalation will not be permitted.

All toxicities are defined according to the revised US National CancerInstitute Common Toxicity Criteria. DLTs are defined in the protocol; ingeneral, however, the nature of a DLT is such that it is consideredunacceptable even in the setting of an incurable solid tumor.

Patients

Inclusion Criteria

The following criteria must be met for inclusion into the study:

1. Male or female patients >18 years of age.

2. Histologically documented advanced solid tumor, who have failedstandard systemic therapy and up to 1 additional systemic therapy, orfor whom standard systemic therapy does not exist.

3. At least one measurable, evaluable, or non-evaluable site of diseaseas defined by Southwestern Oncology Group (SWOG) Solid Tumor ResponseCriteria including tumor marker value that is above the institutionalupper limit of normal.

4. Women of childbearing potential must have a negative serum β-HCGpregnancy test prior to the initiation of study drug. Male and femalepatients of reproductive potential must agree to employ an effectivemethod of birth control throughout the study and for up to 3 monthsfollowing discontinuation of study drug.

5. World Health Organization (WHO) Performance Status Score of ≦2.

6. Life expectancy of at least 3 months.

7. Written informed consent is obtained prior to any screeningprocedures.

Exclusion Criteria

Exclusion from the study is required if any of the following apply:

1. Female patients who are pregnant or breast-feeding. Postmenopausalwomen must be amenorrheic for at least 12 months to be considered ofnon-childbearing potential.

2. Patient has a severe and/or uncontrolled medical disease (i.e.,uncontrolled diabetes, congestive heart failure, myocardial infarctionwithin 6 months of study, chronic renal disease, or active uncontrolledinfection).

3. Patient has a known brain metastasis.

4. Patient has an acute or known chronic liver disease (i.e., chronicactive hepatitis, cirrhosis).

5. Patient has a known diagnosis of human immunodeficiency virus (HIV)infection.

6. Patient has received any investigational agent within 30 days priorto study entry.

7. Patient received chemotherapy within 4 weeks (6 weeks fornitrosoureas or mitomycin C) prior to study entry.

8. Patient received prior radiation therapy within 4 weeks prior tostudy entry.

9. Patient previously received radiotherapy to ≧25% of the bone marrow.

10. Patient had a major surgery within 2 weeks prior to study entry.

11. Patient has a history of non-compliance to medical regimens.

12. Patient has impairment of hepatic, renal or hematologic function asdefined by the following laboratory parameters:

-   -   Platelet count <100×10⁹/L    -   Absolute neutrophil count (ANC) <1.5×10⁹/L    -   Serum ALT (SGPT) or AST (SGOT) >2.5×institutional upper limit of    -   normal (IULN) (>5×IULN for patients with hepatic metastases)    -   Serum total bilirubin >1.5×IULN    -   Serum creatinine >1.5×IULN

13. Patient is <5 years free of another primary malignancy; however,non-melanomatous skin cancer and cervical carcinoma in situ are excludedonly if the patient has active disease.

Sample size This study requires about 40 patients.

Treatments epothilone B is supplied in individual 2 ml glass vialsformulated as 1 mg/1 ml of the clear, colorless intravenous concentrate.The substance is formulated in polyethylene glycol 300 (PEG 300) anddiluted with 50 or 100 ml 0.9% Sodium Chloride Injection, USP, toachieve the desired final concentration of the drug for infusion. It isadministered as a single 30-minute intravenous infusion every 21 daysfor six cycles.

The starting dose level is 0.3 mg/m². This dose is calculated asone-third of the toxic dose low (TDL) in the most sensitive speciesstudied which, for epothilone B, is the dog. Since there are nomortalities at the lower of the 2 doses administered to dogs in the GLPtoxicology study—0.1 mg/kg, repeated once 3 weeks later—the TDL isestimated to be in the range of 0.65 mg/kg. Using a factor of 20 toconvert mg/kg in the dog to mg/m² in humans, this starting dose iscalculated as:⅓×0.05 mg/kg×20 kg/m² =0.3 mg/m²

Dose escalation proceeds according to the scheme outlined above.

The study defines treatment delays, dose reductions, or withdrawal fromtreatment for individuals experiencing hematologic or other toxicitiesknown to result from epothilone B. Treatment continues to a maximum of 6cycles unless the patient experiences disease progression orunacceptable toxicity.

At the end of 6 cycles, patients who have achieved a complete or partialresponse and patients who have had stable disease may continue furthertreatment according to an extension protocol at the discretion of theinvestigator and after approval by the sponsor.

Safety

variables The safety of epothilone Bis assessed by physical examinationand evaluation of vital signs, clinical laboratory results, adverseevents, and use of concomitant medications. Adverse events are bothelicited and volunteered and are graded using the revised US NationalCancer Institute Common Toxicity Criteria.

Efficacy

variables Although this phase 1 study is not designed to detectefficacy, activity is demonstrated as a function of the rate ofobjective tumor response and length of progression-free and overallsurvival. Baseline tumor evaluations include optimal assessment of allmeasurable, evaluable, and nonevaluable disease. Evaluations includephysical examination and chest roentgenogram and, as appropriate,computerized tomogram of the thorax, abdomen and pelvis; sonogram of theabdomen and pelvis; bone scintigram, with bone roentgenogram of allknown osseous lesions; and determination of tumor marker values.Follow-up studies are obtained every two cycles and after cessation oftreatment.

Objective status is clinically evaluated using the Novartis guidelines,which are based on the SWOG response criteria. All complete and partialresponses must be confirmed by a second assessment at least four weekslater. Best tumor response are calculated for each patient using theSWOG response criteria.

Pharmacokinetics The following pharmacokinetic parameters are calculatedand analyzed for cycles 1 and 2: t_(max), C_(max), λ_(Z), t_(1/2), AUC,and R_(A). R_(A)=the ratio of AUCτ_(cycle2)/AUCτ_(cycle1) is evaluatedas an index of accumulation. Preliminary assessment of doseproportionality is based on AUC from the last dose among different dosegroups. PK/PD correlations with observed toxicities (e.g.,hematopoietic) are performed as a predictor of safety.

Pharmacodynamics Tumor biopsy samples are obtained where feasible andaccessible prethereapy and after the first cycle of therapy in order toidentify biological factors that correlate with efficacy and response.

Statistical methods Patients with treatment-emergent clinical adverseevents (especially those with dose-limiting toxicity) or withlaboratory, vital sign, or physical examination abnormalities (newlyoccurring or worsening from baseline) are identified and the values areflagged. The rate of abnormalities is tabulated by cohort. Objectiveresponse rates (including both complete and partial responses) arepresented by cohort. Descriptive statistics are used to summarize thebasic pharmacokinetic parameters by cohort.

Discussion: Taken together, the examples provide evidence that treatmentwith epothilone B is effective

a) also against a tumor where standard treatment fails, e.g. in colontumor where 5-fluorouracil treatment fails, or where TAXOL® treatmentfails;

b) also against a tumor where TAXOL® treatment fails, e.g. lung,especially non-small cell lung cancer, and/or epidermoid, especiallycervical, tumors;

c) also against orthotopic tumors and the formation of metastases, e.g.in prostate tumors;

d) also against breast cancer where in in vitro assays (example 3)epothilone B shows higher activity than TAXOL®.

The preferred dosage regimens center around an area of weekly treatmentwith about ⅓ to ⅔ of the MTD up to treatment once with a dose up to theMTD, with a kind of best treatment area lying at the weekly up tothree-weekly administration.

1. A method for treating a proliferative disease, said method comprisingthe step of administering, in at least one treatment, a therapeuticallyeffective amount of an epothilone, together with a pharmaceuticallyacceptable carrier, to a warm-blooded animal in need of such treatment.2. The method of claim 1 where the epothilone is epothilone B.
 3. Themethod of claim 2 where epothilone B is administered in more than onetreatment with an interval of about one week to about six weeks betweentreatments.
 4. The method of claim 2 where epothilone B is administeredin a dose to humans that is calculated according to the formula (I)single dose (mg/m²)=(0.1 to y)×N   (I) where N is the number of weeksbetween treatments and y is
 6. 5. The method of claim 2 where epothiloneB is administered in a dose to humans that is calculated according tothe formula IIsingle dose (mg/m²)=(0.1 to 2.5)×N   (II).
 6. The method of claim 4where epothilone B is administered weekly in a dose that is betweenabout 0.1 and about 6 mg/m².
 7. The method of claim 4 where epothilone Bis administered every 6 to 8 days in a dose that is between about 0.1and about 5 mg/m².
 8. The method of claim 4 where epothilone B isadministered every 6 to 8 days in a dose that is between about 0.1 andabout 3 mg/m².
 9. The method of claim 4 where epothilone B isadministered every week in a dose between about 0.3 and about 1 mg/m².10. The method of claim 4 where epothilone B is administered every thirdweek in a dose that is between about 0.3 and about 18 mg/m².
 11. Themethod of claim 4 where epothilone B is administered once every 18 to 24days three weeks in a dose that is between about 0.3 and about 12 mg/m².12. The method of claim 4 where epothilone B is administered every 18 to24 days in a dose that is between about 0.3 and about 7.5 mg/m².
 13. Themethod of claim 4 where epothilone B is administered every third week ina dose that is between about 1.0 and about 3.0 mg/m².
 14. The method ofclaim 4 where epothilone B is administered by intravenous infusion. 15.The method of claim 6 where the epothilone is administered byintravenous infusion.
 16. The method of claim 15 where each infusiontakes place during about 5 to about 30 min.
 17. The method of claim 10where epothilone B is administered by intravenous infusion.
 18. Themethod of claim 17 where the infusion takes place during about 5 toabout 30 min.
 19. The method of claim 1 wherein the proliferativedisease is refractory to treatment with one or more chemotherapeuticsother than an epothilone, where epothilone B is administered to a humanin need of such treatment in a dose that is appropriate for thetreatment of said disease.
 20. The method of claim 19 where therefractory tumor to be treated is selected from the group consisting oflung, colorectal, prostate, breast or epidermoid head or neck tumors.21. The method of claim 19, where the epothilone B is administered inmore than one treatment with an interval between treatments of about oneweek to about six weeks after the preceding treatment, respectively. 22.The method of claim 19 where epothilone B is administered by intravenousinfusion in a dose to humans that is calculated according to the formula(I)single dose (mg/m²)=(0.1 to y)×N   (I) where N is the number of weeksbetween treatments which lies between about 1 and about 3 weeks so thatN also is between about 1 and about 3, and y is
 6. 23. The method ofclaim 22 where epothilone B is administered weekly in a dose that isbetween about 0.1 and about 6 mg/m².
 24. The method of claim 22 whereepothilone B is administered every 6 to 8 days in a dose that is betweenabout 0.1 and about 5 mg/m².
 25. The method of claim 22 where epothiloneB is administered every 6 to 8 days in a dose that is between about 0.1and about 3 mg/m².
 26. The method of claim 22 where epothilone B isadministered weekly in a dose between about 0.3 and about 1 mg/m². 27.The method of claim 22 where epothilone B is administered every thirdweek in a dose that is between about 0.3 and about 18 mg/m².
 28. Themethod of claim 22 where epothilone B is administered every 18 to 24days in a dose that is between about 0.3 and about 12 mg/m².
 29. Themethod of claim 22 where epothilone B is administered every 18 to 24days in a dose that is between about 0.3 and about 7.5 mg/m².
 30. Themethod of claim 22 where epothilone B is administered every third weekin a dose that is between about 1.0 and about 3.0 mg/m².
 31. The methodof claim 22 where the infusion takes place during about 5 to about 30min.
 32. The method of claim 22 wherein the tumor to be treated is acolorectal tumor that is refractory to at least one member of the taxaneclass of anti-cancer agents.
 33. The method according to claim 32wherein the colorectal tumor to be treated is in addition refractory toat least one other standard chemotherapeutic.
 34. The method of claim 33where the tumor to be treated is a colorectal tumor that is refractoryto TAXOL and 5-fluorouracil treatment.
 35. The method of claim 22 wherethe tumor to be treated is a prostate tumor, and/or any metastasis,refractory to hormone treatment.
 36. The method of claim 22 where thetumor to be treated is an epidermoid head or neck tumor that isrefractory to treatment with at least one other chemotherapeutic. 37.The method of claim 36 where the epidermoid head or neck tumor isrefractory to treatment with TAXOL.
 38. The method of claim 22, wherethe tumor to be treated is a lung tumor that is refractory to treatmentwith at least one other chemotherapeutic.
 39. The method of claim 38where the tumor to be treated is a non-small cell lung cancer.
 40. Themethod of claim 39 where the non-small cell lung cancer is refractory totreatment with TAXOL.
 41. The method of claim 22 where the tumor to betreated is a breast tumor.
 42. The method of claim 31 wherein the tumorto be treated is a colorectal tumor that is refractory to at least onemember of the taxane class of anti-cancer agents.
 43. The method ofclaim 42 wherein the tumor to be treated is a colorectal tumor that isrefractory to standard chemotherapy.
 44. The method of claim 43 wherethe tumor to be treated is a colorectal tumor that is refractory toTAXOL and 5-fluorouracil treatment.
 45. The method of claim 31 where thetumor to be treated is a prostate tumor, and/or any metastasis thereof,wherein the tumor and/or its metastasis is refractory to hormonetreatment.
 46. The method of claim 31 where the tumor to be treated isan epidermoid head or neck tumor refractory to treatment with at leastone other chemotherapeutic due to multi-drug resistance.
 47. The methodof claim 46 where the epidermoid head or neck tumor is refractory totreatment with TAXOL.
 48. The method of claim 31, where the tumor to betreated is a lung tumor that is refractory to treatment with at leastone other chemotherapeutic.
 49. The method of claim 48 where the tumorto be treated is a non-small cell lung cancer.
 50. The method of claim49 where the non-small cell lung cancer is refractory to treatment withTAXOL®.
 51. The method of claim 31 where the tumor to be treated is abreast tumor.
 52. The method of claim 2 where the proliferative diseaseto be treated is selected from the group consisting of a colorectaltumor, a tumor of the genitourinary tract, an epidermoid tumor, a lungtumor and a breast tumor.
 53. The method of claim 52 where theproliferative disease to be treated is a colorectal tumor that isrefractory to at least one member of the taxane class of anti/canceragents and/or to standard chemotherapy.
 54. The method of claim 52 wherethe proliferative disease to be treated is a prostate tumor.
 55. Themethod of claim 54 where the prostate tumor is refractory to hormonetreatment.
 56. The method of claim 52 where the proliferative disease isan epidermoid head or neck tumor.
 57. The method of claim 56 where thehead or neck tumor is multidrug-resistant.
 58. The method according toclaim 52 where the proliferative disease is a non-small cell lung tumor.59. The method of claim 58 where the non-small cell lung tumor isrefractory to treatment with a member of the taxane class of anti-canceragents.
 60. The method of claim 52 where the proliferative disease is abreast tumor.
 61. The method of claim 60 where the breast tumor isrefractory to treatment with at least one member of the taxane class ofanti-cancer agents.
 62. The method of claim 1 where the proliferativedisease to be treated is a multidrug resistant tumor.
 63. The method ofclaim 1 where the proliferative disease to be treated is selected fromthe group consisting of a melanoma, ovarian cancer, pancreas cancer,neuroblastoma, head or neck cancer, bladder cancer, renal cancer, braincancer and gastric cancer.
 64. The method of claim 19, where epothiloneB is administered in a dose that is between about 1 and about 100% ofthe maximal tolerated dose (MTD) to a human; and one or more furtherdoses each within 1% and 100% of the MTD are administered in at leastone additional treatment after an interval between the treatments of oneto three weeks.
 65. The method of claim 64 where the dose to beadministered is between 25 and 100 % of the MTD.
 66. The method of claim19, where epothilone B is administered weekly to a human in a dose thatis below 80% of the maximal tolerable dose (MTD).
 67. The method ofclaim 66, where the dose is below 50% of the MTD.
 68. The method ofclaim 1, further comprising the step of administering (a) epothilone Bin combination with (b) another antitumor therapeutic, the combinedtreatment being so timed that component (a) and component (b) areadministered to a human in need of such treatment in combination and ina quantity that is jointly therapeutically effective against saidproliferative disease.
 69. The method of claim 2, where theproliferative disease is a tumor that is refractory to the treatmentwith an anti-cancer agent of the taxane class, said tumor being selectedfrom the group consisting of a colorectal, a prostatic, a pancreatic anda brain tumor.
 70. The method of claim 2 where the proliferative diseaseis a multidrug resistant non-small cell lung carcinoma, a multidrugresistant breast tumor, or a multidrug resistant epidermoid head andneck tumor.
 71. The use of an epothilone for the manufacture of apharmaceutical preparation for the treatment of a proliferative disease,comprising admixing said epothilone with a pharmaceutically acceptablecarrier.
 72. The use of claim 71, where the epothilone is epothilone B.